bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Maternal Asthma Modify the Association Between Placental Hormones and Placental Weight? [ID 2683539]
Authors: Hanson Courtney M. , Saizy Sadia , O'Hare Danielle , Schlichting Regina , Subramaniam Akila , Williams Andrew D.
Published: May 2024

INTRODUCTION:

Placental endocrine function is essential for placental growth. Maternal asthma may alter placental growth. The relationship between asthma, placental hormones, and placental size remains understudied. We examined the association between placental hormones and placental weight in pregnant participants with and without asthma.

METHODS:

Hormones influencing placenta function, prolactin (in nanograms per milliliter), lactogen (in nanograms per milliliter), placenta growth hormone (PGH) (in picograms per milliliter), IGF-1 (in picograms per milliliter), and IGF-2 (in nanograms per milliliter), were measured from serum drawn at ∼30 weeks (range, 27–36 weeks) of gestation, categorized into quartiles. Placental weight (in grams) was obtained from placental pathology reports. Data were available for 174 women (134 with asthma; 40 without) from the B-WELL-Mom study. Linear regression models estimated associations between placental hormones and placental weight, adjusted for maternal factors. Models were fit overall, and asthma*hormone interaction terms were fit. We then stratified models by asthma. This analysis was approved by the authors’ home institution IRB.

RESULTS:

Participants were, on average, 31 years old, had high income (47%; >$140,000), and were racially diverse (40% White, 40% Black, 15% Hispanic, 5% mixed race). Mean placental weight (overall, 465.56 g) differed between those with (473.43 g) and without asthma (439.20 g; P<.05). Placental hormone levels also varied by asthma status. In overall regression analyses, high levels of PGH (quartile 4 versus quartile 1) were associated with increased placental weight (68.32 g; 95% CI, 24.23, 112.40). The association between high levels of PGH and placental weight was stronger among women without asthma (127.47 g; 95% CI, 19.22, 235.72) than among those with asthma (66.18 g; 95% CI, 16.33, 116.03; P-interaction=.12).

CONCLUSION:

Our findings suggest the association between PGH and placental weight differs by asthma status. Additional research regarding placental function among women with asthma is warranted to better understand adverse outcomes among pregnancies complicated by asthma.
Effect of COVID-19 on the Cultural Transition Towards the Use of Midwives Over Standard Doctors of Medicine [ID 2683504]
Authors: Wells Brittney , Dickey Erin , Nelson Bridgett , Currier Chase , Kleffner Alison , Halfar Matthew A.
Published: May 2024

INTRODUCTION:

In recent times, the use of midwives as obstetrical providers has become increasingly popular within the United States. Unsurprisingly, the SARS-CoV-2 pandemic (COVID-19) had a large effect on societal trust of health care, including providers, and thus this study aimed to determine whether the pandemic further accelerated the cultural transition towards utilizing midwives as birth attendants.

METHODS:

Using the CDC Natality Database, we reviewed deliveries from 2016 to 2021 of previously healthy mothers, ages 18–35, with singleton pregnancies, measuring incidence of birth attendants including MDs, DOs, nursing midwives, and non-nursing midwives. A binomial model was used to perform logistic regressions to assess whether COVID-19 correlated with alterations in rates of transition of birthing attendants.

RESULTS:

Rates of deliveries attended by MDs declined at a greater extent, whereas births attended by DOs increased at a lesser rate, and nursing midwives and non-nursing midwives increased at a greater rate (change in rates pre-to-post COVID-19: −0.390%, −0.084%, 0.044%, and 0.204%, respectively; P<2.2×10−16). Although this rate of change was small, since the start of COVID-19 there has been an 11% increase in non-MD-attended deliveries, nearly double the rate seen prior.

CONCLUSION:

There has been a significant increase in the number of deliveries attended by DOs, nursing midwives, and non-nursing midwives over the past several decades, even more so since the start of COVID-19. With the transition in the utilization of health care professionals, further investigation needs to be conducted to assess the effects this has on health outcomes of the mother and infant.
Perceptions About Marijuana Use in Pregnancy Among Pregnant Users and Nonusers in a State Without Legalized Recreational Cannabis [ID 2683513]
Authors: Ramseyer Abigail , Kennon-McGill Stefanie , Miron Laura L. , Wells Cheryl H. , Davis Kaitlyn , Ray-Griffith Shona
Published: May 2024

INTRODUCTION:

Cannabis use in pregnancy is rising. The objective of this study is to compare attitudes regarding marijuana use among pregnant users and nonusers.

METHODS:

This was a prospective study (IRB #262700) in which a 35-question, anonymous survey was distributed to pregnant patients at outpatient prenatal visits across gestation. Questions included topics regarding marijuana use in pregnancy, perceived risks, and provider–patient education.

RESULTS:

408/460 (88.7%) approached pregnant patients completed the survey. Self-reported rate of marijuana use during pregnancy: 11.8% (48/408). There were no ethnic differences in users and the most common age for use was 18–24 years (24/48). 79% (38/48) reported use two to three times weekly or greater. Average response score (Likert scale) for participants using marijuana compared to those who did not to the following statements were statistically significant and positive towards prenatal use: belief that pregnant patients should refrain from marijuana use: 2.31 versus 3.53 (<.001); acceptability of medical marijuana: 3.68 versus 2.82 (<.001); minimal health risk: 4.15 versus 2.96 (<.001); support for legalization of recreational marijuana: 4.58 versus 3.51 (<.001). Lack of counseling on cessation and risk of cannabis use in pregnancy were reported by 82% and 84% of participants with 74% of current users reporting lack of counseling. 54% of users desired more information regarding cannabis-related pregnancy complications.

CONCLUSION:

Higher-than-expected self-reported marijuana use during pregnancy. Lack of counseling on risks of marijuana use and importance of cessation highlight an important opportunity for counseling and intervention supporting current ACOG guidelines of SBIRT (screening, brief intervention, and treatment referral).
Assessing Patient's Feelings About Their Pregnancy: A Preliminary Qualitative Exploration of Conversations Between Obstetric Clinicians and Pregnant Patients at the First Prenatal Visit [ID 2683659]
Authors: Picciotto Andrea , Chang Judy C.
Published: May 2024

INTRODUCTION:

During the first prenatal visit, some patients may feel overwhelmed, ambivalent, or undecided about continuing the pregnancy. Understanding a patient’s feelings about the pregnancy can allow obstetric clinicians to offer support, resources, and options. Few studies have empirically examined how obstetric providers assess patient’s feelings about their pregnancy.

METHODS:

We analyzed transcripts of audio-recorded patient–obstetric clinician first obstetric visits for discussions exploring the patient’s feelings, intentions, or desires regarding their pregnancy. These discussions were then coded for content and communication approach.

RESULTS:

We coded 100 transcribed visits. Discussions about pregnancy intent, desire, or feelings occurred in 70 visits. In 11 visits, the clinician used an open-ended neutral question (eg, “how are you feeling about this pregnancy?”). Fifteen clinicians expressed assumptions about the patient’s feelings regarding the pregnancy (eg, “congratulations!”). Fifty-seven clinicians specifically asked about intendedness (eg, “Was this a planned pregnancy?). Twenty-one addressed the topic with leading statements (eg, “but you want to keep the baby, right?”). Of the 53 patients that admitted to an unplanned pregnancy, only 42 (79%) of these conversations were further explored—29 (54%) specifically only asked about patient’s desire to continue the pregnancy; 13 (24%) provided additional options counseling, information, or support.

CONCLUSION:

Few obstetric clinicians explored the feelings and desires about the pregnancy during first obstetric visits. Further work is needed to explore improved methods of addressing how patients feel about their pregnancy.
Melanoma in Pregnancy: A Shocking Report [ID 2683420]
Authors: Dubey Shresttha , Montes Andres I.
Published: May 2024

INTRODUCTION:

This case describes the clinical course of a 25-year-old patient presenting for her 16-week obstetric check who was emergently diagnosed with stage 4 melanoma with metastasis to the oral cavity, liver, and skin. The young age of the patient and rapid advancement of the disease make this case worthy of attention. The study of this patient is designed to provide context and data for the actively growing body of literature on the potential relationship between pregnancy and melanoma, which is not currently understood. The goal of this case report is to contribute to the current literature, which is divided on whether there is a relationship between melanoma and pregnancy and whether a potential relationship is clinically relevant.

METHODS:

The hospital course of the patient was studied and written out in case report format. Patient consent was obtained to present her hospital course at conferences.

RESULTS:

Excisional biopsy of subcutaneous flank nodule was done, which confirmed diagnosis of stage 4 melanoma. The patient was started on chemotherapy, and treatment is ongoing.

CONCLUSION:

The case of a 25-year-old pregnant patient who was found to have stage 4 melanoma with metastasis has an important role in the ongoing investigation of the potential relationship between pregnancy and melanoma. This case is noteworthy because of the young age of the patient, the aggressive spread of the disease, and the ethical questions raised when treating cancer in a pregnant patient.
Association of Low Levels of Placental Growth Factor and Fetal Growth Restriction in a Setting With a High Prevalence of Diabetes [ID 2683431]
Authors: Figueiro-Filho Ernesto A. , Vinken Jamie , Versteeg Kathryn , Orieux Alyx , Grzyb Karolina
Published: May 2024

INTRODUCTION:

Placental growth factor (PlGF) is a glycosylated protein from the vascular endothelial growth factor (VEGF) family that is involved in placental angiogenesis. In cases of placental dysfunction, decreased maternal serum PlGF levels predict the development of pregnancy complications such as preeclampsia, fetal growth restriction (FGR), and stillbirth.

METHODS:

Datasets from 114 high-risk patients who had clinical indication for PlGF testing from 2021 to 2023 were collected retrospectively. The anonymized dataset comprises PlGF test results categorized by gestational age-specific ranges and FGR categorized by percentile. Chi-squared analysis of 114 patients was used to assess the association between PlGF levels and FGR (less than 10th percentile). This study was approved by REb-USask #Bio3702.

RESULTS:

Of the 114 patients, 21 (18.4%) with low/very low PlGF and 8 (7.1%) with borderline/normal PlGF had fetuses with FGR less than 10th percentile. There was a significant difference between groups with a low/very low PlGF and normal PlGF levels (P<.001). The negative predictive value (NPV) for development of FGR less than 10% was 97.54%.

CONCLUSION:

Data collection is ongoing; however, in our patient population with a high prevalence of diabetes, preliminary data from 114 patients suggest that gestational age-stratified maternal serum PlGF levels have high NPV value for development of FGR less than 10th percentile. The implementation of this simple laboratory test in rural and remote communities would allow for earlier identification of pregnancies that require more intensive surveillance at a high-risk center of care.
Compliance With CDC-Recommended 7-Day Chlamydia Treatment in Nonpregnant Adult Female Patients in Low-Resource Communities: 1-Year Data [ID 2683472]
Authors: Pyle Adrienne , David Rochelle , Onukwube Sopuruchukwu I. , Plastino Kristen A.
Published: May 2024

INTRODUCTION:

In 2021, the Centers for Disease Control and Prevention (CDC) changed treatment guidelines for chlamydia (Chlamydia trachomatis) infections in nonpregnant women, as substantial data demonstrated oral doxycycline at 100 mg twice daily for 7 days as superior to one-dose oral azithromycin at 1 g. Previously, the two antibiotic regimens were considered equivocal, allowing providers to opt for the shorter regimen course to optimize compliance and cure rate.

METHODS:

We assessed the compliance rate of patients in low-resource communities to the multidose doxycycline regimen via retrospective chart review. For a 12-month period, all nonpregnant adult female patients prescribed doxycycline for chlamydia infection at a county hospital system were included in the IRB-exempt study. Patients were called 7–10 days after initial doxycycline prescription to assess compliance, medication side effects, and adherence barriers. Noncompliant patients were offered a prescription for the azithromycin regimen. Patients were encouraged to repeat chlamydia testing in 4 weeks to assess for cure, or in 3 months for reinfection.

RESULTS:

Two hundred sixty-four patients met inclusion criteria, 193 (73.1%) of whom could be contacted. Patients were significantly compliant to multidose doxycycline despite barriers (P=.0002; 95% CI, 3.33–50.48), such as pharmacy-induced medication fill delay and medication side effects. Only 7 (58.3%) noncompliant patients desired to switch to azithromycin. Of the 105 compliant patients re-tested, most (87.6%) tested negative.

CONCLUSION:

The data demonstrated that patients in low-resource communities are significantly compliant with the CDC-recommended 7-day doxycycline regimen despite barriers to adherence. Therefore, even in low-resource communities, practitioners should prescribe multidose doxycycline for chlamydia infection in nonpregnant females.
Examining Accessibility of Freestanding Abortion Clinics for People With Disabilities [ID 2683401]
Authors: Alpern Rebecca R. , Folarin-Amode Faridat , Or Maya , Jamshidi Roxanne
Published: May 2024

INTRODUCTION:

People with disabilities face numerous barriers to equitable health care but have a fundamental right to safe abortion care. This study reviews the accessibility of freestanding abortion clinics in the United States for those with disabilities.

METHODS:

A quantitative data analysis was performed. All freestanding abortion clinics registered with the Abortion Care Network were included except those directly affiliated with a university or general gynecology clinic and those exclusively operating online. Two independent reviewers analyzed clinic websites after an interrater reliability test. Independent variables analyzed included Flesch Reading Ease score, presence of a statement affirming dignity for all persons, online appointment scheduling, transparent pricing, and financial assistance information.

RESULTS:

Seventy-two clinics were included. No clinic explicitly stated that their facilities were accessible to individuals with disabilities. Fifty-four percent had a statement affirming dignity for all persons, most of which were in the Northeast or West Coast. 6% had an accessibility widget, and 63% had online appointment scheduling. Mean Flesch Reading Ease score was 55.37 correlating to a 10th- to 12th-grade reading level. 33% had transparent pricing information, and 71% offered information on financial assistance.

CONCLUSION:

Several accessibility barriers were identified on these websites. Freestanding abortion clinics should focus on enhancing accessibility by explicitly affirming dignity for all patients, providing clear information on facility accessibility, and implementing an accessibility widget, online scheduling, and transparent pricing. Furthermore, these websites should be written at an easily comprehensible reading level. These simple changes would make these clinics more accessible for those with disabilities.
Patient Satisfaction With Over-the-Phone Interpretation in an Outpatient Gynecology Clinic [ID 2683580]
Authors: Gomez Daniel A.
Published: May 2024

INTRODUCTION:

In Miami, Florida, the majority of households are bilingual or non-English speaking, often necessitating use of translation services in clinical settings. Culturally competent care includes using a language that patients understand, which can lead to improved clinical outcomes. Over-the-phone translation is the only method of interpretation available in our public safety net outpatient gynecology clinic. To our knowledge, no study has explored patient satisfaction and comfort with this mode of interpretation in a gynecology clinic.

METHODS:

An anonymous 33-item Spanish language survey, adapted from existing studies on medical translation, was used to assess the translation experience for adult patients. Surveys were collected verbally and in-person immediately after a clinic visit in which over-the-phone translation services were used. A Likert-type scale (1, very bad, to 4, very good) was used to assess satisfaction domains.

RESULTS:

Twenty-nine Spanish-speaking participants completed the survey. The median age was 47.5 years. Over 75% (n=22) were uninsured and close to 50% had not completed high school/GED (n=14). Mean satisfaction with interpretation (3.55) and medical care (4) were high. However, 14% (n=4) felt disrespect by their interpreter, 10% (n=3) expressed dissatisfaction with their understanding of treatment plans, and 10% (n=3) reported issues of privacy with the interpreter. In participants over age 40 (n=19) and with less than a high school education (n=14), there was more discomfort in discussing medical history using the interpreter compared to less than 40 and college-educated respondents. 65% (n=19) of all respondents indicated a preference for an in-person professional interpreter.

CONCLUSION:

Although further research is needed, this study highlights potential concerns, particularly in older and less-educated patients, with over-the-phone translation services in the outpatient gynecology clinical setting. In settings where patients are likely to be non-English speaking, providing optimal translation services is crucial to both patient satisfaction and culturally competent care.
Are We Screening the Wrong Person?: A Scoping Review on Screening Men for Perpetration of Intimate Partner Violence [ID 2683612]
Authors: Soliman Omnia , Charles Lolayemi , Dada Mary , Beauchemin Esther , Ades Veronica
Published: May 2024

INTRODUCTION:

The United States Preventive Services Task Force (USPSTF) currently does not recommend screening men for perpetration of intimate partner violence (IPV) because of a lack of evidence. Screening women for victimization of IPV has demonstrated limited effectiveness; screening potential perpetrators may be a more useful strategy for the identification and prevention of IPV. The objective of this study is to determine whether there is sufficient evidence to recommend screening men for perpetration of IPV.

METHODS:

We performed a scoping review to identify studies that screen for male perpetration of IPV. We included peer-reviewed, full-text English-language studies that screened men for perpetration of IPV or evaluated an IPV screening tool. Review articles, meta-analysis papers, and studies that only screened women were excluded.

RESULTS:

Of the 834 studies reviewed, the primary objective of 12.1% of studies was determining the prevalence of male perpetration of IPV. The most commonly used screening tools for IPV were the Conflict Tactic Scale (CTS) (23.1%) or CTS-2 (29.0%). The 10th to 90th percentile of reported physical IPV perpetration ranged from 8.10% to 44.40% with a median of 21.80%.

CONCLUSION:

There is an abundance of studies examining male perpetration of IPV, and most use the CTS or CTS-2. These studies indicate that it is feasible to assess men for perpetration of IPV; however, the length of the available questionnaires is prohibitive toward use in a medical setting. We recommend a shorter version of the CTS-2 be developed and validated for use in clinical settings.
Pathogenic BRCA Variants in the Ashkenazi Jewish Population: A Retrospective Study [ID 2683559]
Authors: Barkan Samantha , Kuizon Carmelle M. , Ruiz-Pelaez Juan G. , Etkin-Kramer Elizabeth
Published: May 2024

INTRODUCTION:

Pathogenic variants in BRCA genes (BRCA-PV) increase risk for cancers. Established guidelines for BRCA-PV risk reduction include surveillance, chemoprevention, and surgery. Ashkenazi Jews (AJ) have increased prevalence of BRCA-PVs versus the general population: 1/40 versus 1/160. Population testing of AJs, testing based on ancestry alone, identifies more BRCA-PV carriers than testing based on family history.

METHODS:

Charts of 683 AJ patients tested in a gynecology office for BRCA-PVs between January 1, 2017, and June 30, 2020, were retrospectively reviewed for BRCA-PV status, history, and clinical management. Findings were compared to 2017 National Comprehensive Cancer Network (NCCN) guidelines, current at time of testing. Patients were appropriately counseled for clinical management.

RESULTS:

Six hundred eighty-three AJs, mean age 51.0±13.5 years, were tested for BRCA-PVs: 14 tested positive (2%), mean age 41.6±14.16; 13/14 (93%) were female. Of patients with PV, 6 (43%) patients did not qualify for screening based on 2017 guidelines. Of positive female patients, 7 (54%) chose risk-reducing bilateral salpingo-oophorectomy (rrBSO), 4 (31%) chose mastectomy, 3 (21%) chose in vitro fertilization with wild-type embryos. One patient was found to have invasive serous tubal cancer at rrBSO; another with ER− breast cancer with first screening MRI.

CONCLUSION:

Our study confirms increased BRCA-PV prevalence amongst AJs. Over half of individuals tested did not meet 2017 NCCN criteria, including two positive patients diagnosed with cancer—indicating that 2017 criteria did not capture at-risk individuals. Updated guidelines recommending BRCA-PV testing of AJs must be implemented to identify actionable PVs and initiate cancer prevention strategies.
Transvaginal Ultrasound Simulation/Curriculum for Third-Year Medical Students Improves Educational Experience on Obstetrics and Gynecology Clerkship [ID 2683421]
Authors: Hartup Lindsay A. , Medrano Gabriel A. , Lewis Ariana
Published: May 2024

INTRODUCTION:

The purpose of this study was to assess the effect of transvaginal ultrasound (TVUS) curriculum with simulation on third-year medical students' obstetrics and gynecology clerkship.

METHODS:

Institutional review board approval was waived for this study. The TVUS curriculum was introduced in May 2023. A 2-hour educational session with simulation was held at the beginning of the 6-week obstetrics and gynecology clerkship. At the end of the clerkship, a survey was administered to assess students’ experience and comfort level with TVUS. Students who completed their obstetrics and gynecology clerkship prior to the curriculum (July 2022 to April 2023) or were not present for the TVUS educational session were administered the same survey. Likert scale responses were compared using ordered logistic regression.

RESULTS:

Forty-one of 69 students present for the TVUS curriculum, and 66 of 187 who were absent, completed the post-clerkship survey. Students present for the TVUS curriculum were more likely to report greater understanding of the TVUS they observed during their obstetrics and gynecology clerkship (OR 2.63 [1.25, 5.65]; P=.012). They were more likely to report increased comfort recognizing normal anatomy (OR 5.18 [2.42, 11.59]; P<.001), and gynecologic pathology (OR 8.40 [3.84, 19.24]; P<.001), on real-time TVUS. Additionally, they were more likely to report increased overall understanding on their obstetrics and gynecology clerkship because of their TVUS knowledge and experience (OR 5.47 [2.56, 12.20]; P<.001).

CONCLUSION:

Universal implementation of TVUS curriculum with simulation should be considered in undergraduate medical education given the potential to improve educational experience on the obstetrics and gynecology clerkship.
Effect of Texas Abortion Laws on Reproductive Health Attitudes Among Medical Students, Residents, and Faculty: A TTUHSC Study [ID 2683579]
Authors: Finney Caroline E. , Nanni Amber , Sauers Delaney , Mallik Avantika , Chaudhury Hannah , Chaudhury Tristin
Published: May 2024

INTRODUCTION:

In response to Texas Senate Bill 8 and the overturning of Roe v. Wade, we investigated the effect of new abortion laws on attitudes toward reproductive health and abortion within the TTUHSC community in Lubbock, Texas. As abortion remains a vital aspect of reproductive health care, understanding current and future doctors’ sentiments is essential.

METHODS:

The Omnibus survey was sent electronically to TTUHSC School of Medicine students as well as medical residents, fellows, and faculty. The survey included 25 question sets that branched according to respondent groups and received 318 responses from the TTUHSC community. Using a single predictor model in RStudio, we analyzed gender influence on attitudes toward post-law changes. All participants provided consent for their responses to be used for research purposes. This project was approved for exempt review by the TTUHSC IRB.

RESULTS:

Of 76 responses, 63% strongly agreed that medical education should address Texas abortion law changes. Females showed more desire (73%) for education changes (P=.0059). Gender also affected opinions on counseling limitations due to new laws (P=.0167) and obstetrics and gynecology residents’ abortion training (P=.0063).

CONCLUSION:

Most participants favored educating students about law changes, perceived counseling limitations, and obstetrics and gynecology training for abortions. Females consistently aligned with these sentiments. The gender-based disparities underscore a medical education gap exacerbated by the new laws. Ambiguities in current laws may affect clinical practice. Addressing these findings is crucial and encompasses integrating ethical considerations, legal nuances, and procedures into the medical education framework to produce competent, compassionate practitioners.
Change in Medical Students' Attitudes Towards Family Planning After Pregnancy Counseling Panel Intervention [ID 2683614]
Authors: Peipert Leah J. , Brown Lucy , King Carli , Stout Julianne , Caldwell Amy
Published: May 2024

INTRODUCTION:

Abortion is one of the most commonly performed procedures in the United States, but abortion education is lacking in medical curricula. This study evaluates changes in medical students’ attitudes after a pregnancy counseling panel intervention during preclinical medical education.

METHODS:

Second-year medical students participated in a “Pregnancy Options Panel” with obstetrician–gynecologists, a pediatrician, and a social worker. Using a case study format, panelists guided discussion of appropriate care for a patient diagnosed with an unintended pregnancy. Two identical 19-item surveys were disseminated before and after the panel to assess students’ comfort/beliefs about pregnancy counseling and treatment. Statistical analyses were performed to compare responses. The study was IRB exempt.

RESULTS:

The class was composed of 366 students: 207 (60.5%) completed the pre-survey and 181 (49.5%) completed the post-survey. Students reported increased comfort when contemplating referral to an abortion provider, prescribing medication abortion, and performing a surgical abortion after the panel compared to before the panel (P<.01). Students were more likely to withhold disclosing their personal beliefs about abortion when counseling a pregnant patient (64.6% versus 42.3%; P<.01), felt more capable of counseling patients in a neutral manner (86.4% versus 71.6%; P<.01), and had a significant increase in preparedness to pregnancy options counseling (P<.01).

CONCLUSION:

Medical students felt more prepared to counsel patients without bias of their own beliefs after the pregnancy options counseling panel. Expert panels comprised of health professionals with diverse perspectives on pregnancy options can improve preclinical medical curriculum on the often-neglected topic of abortion.
“It Is Challenging to Knowingly Cause Discomfort”: Medical Students' Experiences With Ethical Dilemmas and Professionalism During the Obstetrics and Gynecology Clerkship [ID 2683534]
Authors: Gliwa Catherine , Schmidt Alison , Knapp Frances , Hess Andrea L. , Loder Charisse
Published: May 2024

INTRODUCTION:

Medical students often encounter ethical dilemmas in obstetrics and gynecology clinical training, yet receive limited directed education to help them interpret and process these situations. We sought to explore students’ described experience with clinical ethical complexities to identify sources of conflict and inform training improvements.

METHODS:

From 2019 to 2022, medical students who submitted an essay assignment to describe an ethical dilemma encountered during their obstetrics and gynecology clerkship were invited to share their work with the study team. We performed thematic analysis of these essays.

RESULTS:

Thirty-nine essays were available for analysis. Prominent themes included patient autonomy, informed consent, approaches to counseling, power differentials, professionalism, and the learning environment and its effect on patient care. The following are sample quotes: “Each time a patient requested that a medical student not be involved in their care they often occupied positions of privilege by title, socioeconomic status, or race.”; “This was a difficult, uncomfortable experience. It is challenging to knowingly cause discomfort.”; “I wondered, and still wonder—should I have intervened? [...] I did not have the courage to speak up, but I wish I did.”

CONCLUSION:

Students bear witness to and learn from ethical conflicts during obstetrics and gynecology training, which can prompt both self-reflection and cognitive dissonance. Topics such as informed consent and patient autonomy are commonly taught in medical schools; in practice, students also identified dilemmas related to their roles as learners navigating team-based health care. Medical students may need additional ethical training or support in processing the hierarchies of academic medicine.
Greater mechanistic understanding of the cutaneous pathogenesis of Stevens–Johnson syndrome/toxic epidermal necrolysis can shed light on novel therapeutic strategies: a comprehensive review
Authors: Ogiji Emeka D. , Aboheimed Nourah , Ross Kehinde , Voller Calum , Siner Ryan , Jensen Rebecca L. , Jolly Carol E. , Carr Daniel F.
Published: May 2024

Purpose of review

Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) are severe cutaneous adverse drug reactions (SCARs) characterized by widespread epithelial detachment and blistering, which affects the skin and mucocutaneous membranes. To date, therapeutic interventions for SJS/TEN have focused on systematic suppression of the inflammatory response using high-dose corticosteroids or intravenous immunoglobulin G (IgG), for example. No targeted therapies for SJS/TEN currently exist.

Recent findings

Though our understanding of the pathogenesis of SJS/TEN has advanced from both an immunological and dermatological perspective, this knowledge is yet to translate into the development of new targeted therapies.

Greater mechanistic insight into SJS/TEN would potentially unlock new opportunities for identifying or repurposing targeted therapies to limit or even prevent epidermal injury and blistering.
Pains Revisited
Authors: Loeser John D. , Ballantyne Jane C.
Published: May 2024

Objectives:

The management of pain patients has not evolved as rapidly as envisioned when IASP was founded almost 50 years ago. We sought to identify factors that could contribute to this situation, with a focus on concepts of pain and the education of pain physicians.

Methods:

Relevant literature describing new strategies for diagnosing and managing patients with high-impact chronic pain was reviewed.

Results:

It appears that the acute–chronic dichotomy has outlived its usefulness and pains should be identified as of peripheral origin or due to central processing errors. Pains of peripheral origin and those of central processing errors require different diagnostic and therapeutic strategies.

Discussion:

Peripheral treatments and opioids are not effective for central pains. When the cause of the pain lies in the central nervous system, a more centrally focused approach is needed to minimize wasteful pursuit of peripheral causes. The education and training of pain physicians should reflect the skills needed to address these 2 very different clinical problems.
Exposure to Operative Anesthesia in Childhood and Subsequent Neurobehavioral Diagnoses: A Natural Experiment Using Appendectomy
Authors: Silber Jeffrey H. , Rosenbaum Paul R. , Reiter Joseph G. , Jain Siddharth , Hill Alexander S. , Hashemi Sean , Brown Sydney , Olfson Mark , Ing Caleb
Published: May 2024

Background

Observational studies of anesthetic neurotoxicity may be biased because children requiring anesthesia commonly have medical conditions associated with neurobehavioral problems. This study takes advantage of a natural experiment associated with appendicitis to determine whether anesthesia and surgery in childhood were specifically associated with subsequent neurobehavioral outcomes.

Methods

This study identified 134,388 healthy children with appendectomy and examined the incidence of subsequent externalizing or behavioral disorders (conduct, impulse control, oppositional defiant, attention-deficit hyperactivity disorder) or internalizing or mood or anxiety disorders (depression, anxiety, or bipolar disorder) when compared to 671,940 matched healthy controls as identified in Medicaid data between 2001 and 2018. For comparison, this study also examined 154,887 otherwise healthy children admitted to the hospital for pneumonia, cellulitis, and gastroenteritis, of which only 8% received anesthesia, and compared them to 774,435 matched healthy controls. In addition, this study examined the difference-in-differences between matched appendectomy patients and their controls and matched medical admission patients and their controls.

Results

Compared to controls, children with appendectomy were more likely to have subsequent behavioral disorders (hazard ratio, 1.04; 95% CI, 1.01 to 1.06; P = 0.0010) and mood or anxiety disorders (hazard ratio, 1.15; 95% CI, 1.13 to 1.17; P < 0.0001). Relative to controls, children with medical admissions were also more likely to have subsequent behavioral (hazard ratio, 1.20; 95% CI, 1.18 to 1.22; P < 0.0001) and mood or anxiety (hazard ratio, 1.25; 95% CI, 1.23 to 1.27; P < 0.0001) disorders. Comparing the difference between matched appendectomy patients and their matched controls to the difference between matched medical patients and their matched controls, medical patients had more subsequent neurobehavioral problems than appendectomy patients.

Conclusions

Although there is an association between neurobehavioral diagnoses and appendectomy, this association is not specific to anesthesia exposure and is stronger in medical admissions. Medical admissions, generally without anesthesia exposure, displayed significantly higher rates of these disorders than appendectomy-exposed patients.

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Assessing the Effectiveness of a Unique Visual Aid in Improving Women's Knowledge of the Hysterectomy Procedure [ID 2683416]
Authors: Fiuza Angelica , Panchal Disha D. , Sproul Wesley A. , Colon Katia M. , Dotterweich Kathryn A. , Howard David L.
Published: May 2024

INTRODUCTION:

This study aims to determine the efficacy of a visual aid in improving women's knowledge of the hysterectomy procedure. Currently, there is a lack of literature that examines evidence-based hysterectomy patient education, and a recent literature review stated that there is a deficit in education surrounding the different hysterectomy treatment options.

METHODS:

This is IRB study #Pro2021000882. Patients were recruited from the Department of Obstetrics, Gynecology & Reproductive Health at the Ambulatory Care Center at University Hospital in Newark, New Jersey. Participants consented and patient information was de-identified. Participants completed a 28-question pre-test, watched the visual aid in either English or Spanish, and then completed the same 28-question post-test. For both English- and Spanish-speaking participants, the percentage of participants who answered each pre- and post-test question correctly was calculated. Finally, average pre-test scores were compared to average post-test scores for each language.

RESULTS:

After watching the video, average test scores of English-speaking (N=30) participants increased by 19.76 (95% CI: 10.9, 28.6) percentage points, whereas Spanish-speaking (N=20) participants increased by 28.93 (95% CI: 19.7, 38.1) percentage points. From the 28-question knowledge test, there were 15 questions in the English version and 23 questions in the Spanish version where the percent of respondents who answered that question correctly after watching the video improved by 20 percentage points or greater compared to before watching the video.

CONCLUSION:

Our preliminary data provide evidence that the hysterectomy visual aid/video we created significantly improves knowledge of the hysterectomy procedure as measured by a validated hysterectomy knowledge quiz.
Association Between Maternal Age and Postpartum Assessment of High-Grade Cervical Dysplasia Diagnosed in Pregnancy [ID 2683560]
Authors: Mulder Isabelle , Nambiar Anjali , Holloway Steven Blaine , Pruszynski Jessica , Lea Jayanthi , Martin Robert B.
Published: May 2024

INTRODUCTION:

The incidence of cervical dysplasia in pregnancy is expected to rise as patients delay childbearing. Historical studies have quoted high rates of postpartum regression of lesions diagnosed in pregnancy. We sought to evaluate the relationship between maternal age and postpartum progression, regression, and persistence of high-grade lesions.

METHODS:

This is a retrospective cohort study of patients with biopsy-proven high-grade dysplasia diagnosed during pregnancy from January 2013 to December 2022. Institutional review board approval was obtained. Only immunocompetent patients with postpartum pathology obtained within 1 year of delivery were included. Definitions based on postpartum pathology were as follows: regression as low-grade or resolved dysplasia, persistence as high-grade dysplasia, and progression as invasive cervical cancer. Results were stratified by maternal age (≤24, 25–29, 30–34, 35+) and data were analyzed using the Cochran–Armitage test.

RESULTS:

Among our cohort (N=286), 101 (35%) were diagnosed with CIN2, 181 (63%) with CIN3/CIS, and 4 (1%) with HSIL (not otherwise specified) on antepartum cervical biopsy. Average age was 28 (±4.2) years. Postpartum regression rate was 44% for patients aged 24 years or younger, 37% in ages 25–29, 33% in ages 30–34, and 33% in ages 35 or older (P=.174). Persistence was common (55%, 63%, 67%, and 64%, respectively) and apparent progression to cancer was rare, occurring in 1% of patients aged 24 years or younger and in 2.8% of patients 35 or older (P=.68).

CONCLUSION:

Persistence occurred in over half of patients, regardless of age. Our findings emphasize the importance of postpartum follow-up, and possible cervical excision, in patients with antepartum high-grade dysplasia.
Maternal Risk Factors for Respiratory Syncytial Virus Lower Respiratory Tract Infection in Otherwise Healthy Preterm and Term Infants: A Systematic Review and Meta-analysis
Authors: Manzoni Paolo , Viora Elsa , Lanari Marcello , Iantomasi Raffaella , Montuori Eva Agostina , Rodgers-Gray Barry , Waghorne Nicola , Masturzo Bianca
Published: May 2024

Background/objective:

To date, there is no published, formal assessment of all maternal risk factors for respiratory syncytial virus lower respiratory tract infection (RSV-LRTI) in infants. A systematic literature review and meta-analysis were undertaken to ascertain: What maternal risk factors are associated with an increased risk of RSV-LRTI in infants?

Methods:

The systematic literature review used explicit methods to identify, select and analyze relevant data. PubMed, Embase and the Cochrane Library were searched (November 2022) using terms regarding: (1) RSV/LRTI; (2) risk factors; (3) pregnant/postpartum population. Bayesian meta-analysis compared RSV hospitalization (RSVH) risk in infants born to mothers with or without certain risk factors.

Results:

A total of 2353 citations were assessed and 20 were included in the final review (10 individual studies; 10 pooled analyses). In 10 studies examining infants (<1 year) without comorbidities (primary outcome), 10 maternal risk factors were associated with RSV-LRTI/RSVH in multivariate analyses. Meta-analysis revealed smoking while pregnant increased infant RSVH risk by 2.01 (95% credible interval: 1.52–2.64) times, while breast-feeding was protective (0.73, 95% credible interval: 0.58–0.90). Risk scoring tools have reported that maternal risk factors contribute between 9% and 21% of an infant’s total risk score for RSVH.

Conclusions:

A greater understanding of maternal risk factors and their relative contribution to infant RSV-LRTI will enable more accurate assessments of the impact of preventive strategies.
Blastocystis hominis-associated Acute Appendicular Peritonitis in a 9-Year-old Boy: A Case Report and a Comprehensive Review of the Literature
Authors: Arredondo Montero Javier , Sáez Álvarez Samuel , Bronte Anaut Mónica , López Medrano Ramiro , Remacha Esteras María Antonia , Rodríguez Ruiz María , Izquierdo García Francisco Miguel
Published: May 2024

Although Blastocystis sp. has been classically considered a commensal parasite with limited pathogenicity, recent studies suggest that its pathogenic potential is high. We report the case of a 9-year-old Spanish male who presented with peritonitis secondary to acute appendicitis with abundant intra-abdominal turbid-free fluid. A standard appendectomy was performed, and a sample of the fluid was taken for microbiological culture. Multimicrobial flora was isolated in peritoneal fluid culture. The antibiotic resistance study showed that all the microorganisms were sensitive to meropenem. On the 5th postoperative day, a control blood test showed relative eosinophilia and a persistently elevated C-reactive protein. A stool parasitological study showed abundant cysts morphologically compatible with Blastocystis hominis. The hematoxylin & eosin and Giemsa study identified abundant parasitic cysts in the appendix. The patient evolved favorably and is currently asymptomatic and under follow-up. Regarding acute appendicitis, there is only one report in the literature of peritonitis of appendiceal origin associated with Blastocystis sp. In conclusion, although infrequent, parasitosis should be considered as a potential etiological agent of acute appendicitis, even in nonendemic areas. Relative eosinophilia or persistently elevated acute phase reactants despite adequate antibiotic coverage should help to establish diagnostic suspicion.
Combination Treatment With Varenicline and Nicotine Patch on Smoking Cessation Outcomes in Heavy Drinkers at 26-Week Follow-up
Authors: Robinson Layne E. , Didier Nathan , Thomas Riya , Vena Ashley , King Andrea
Published: May 2024

Purpose/Background

People who smoke cigarettes and drink alcohol heavily are less likely to quit smoking compared with those who do not drink heavily. The current study examined the effects of a 12-week treatment phase of combination varenicline and nicotine patch compared with placebo and nicotine patch on smoking cessation (primary outcome) and alcohol consumption (secondary outcome) in heavy drinking smokers at 26-week follow-up.

Methods/Procedures

Participants were daily smokers who met heavy drinking criteria. They were randomly assigned to receive either varenicline and nicotine patch (n = 61) or placebo and nicotine patch (n = 61) for 12 weeks. At week 26, self-reports of point prevalence cigarette abstinence were biochemically confirmed, and past-month alcohol drinking days and heavy drinking days were assessed.

Findings/Results

At week 26, smoking quit rates did not differ by treatment group (25% varenicline and 26% placebo). Relative to week 12 outcomes, week 26 quit rates significantly dropped off in the varenicline group but not in the placebo group. Alcohol drinking reductions for the whole sample that were previously observed from baseline to week 12 were sustained at week 26, although they did not differ between treatment groups.

Implications/Conclusions

In heavy drinking smokers, smoking cessation success was evident in a quarter of the total sample at 3 months postmedication discontinuation. At this time, quit rates were the same between those who received varenicline and nicotine patch and those who received nicotine patch alone. Future research is warranted to examine what may aid in longer-term smoking quit rates in heavy drinking smokers.
Assessing Justice, Equity, Diversity, and Inclusion Best Practices for Test Item Writing at a Physician Assistant Program: A Retrospective Analysis
Authors: Wright Hannah R. , Nelson Courtney E. , Toussaint Michele , Ip Eric J.
Published: May 2024

Introduction

Outcomes for specific racial and ethnic groups during the COVID-19 pandemic and the widespread protests demanding racial justice in 2020 renewed a focus on health equity practices and bias in medical education. Routine inclusion of sociodemographic identifiers such as sex/gender, age, race, and/or ethnicity in test items risks perpetuation of implicit bias and race-based practices in medical education.

Methods

A retrospective review was conducted of test items in a pathophysiology course series at an academic medical center in the Western United States. Sociodemographic identifiers in multiple choice test items were reviewed to determine clinical relevance.

Results

Of 795 test items, 475 referred to sociodemographic information (gender, race/ethnicity, age, sexual orientation) and in only 27.5% of questions, this inclusion was clinically relevant (131/475).

Discussion

Current evidence suggests that routine inclusion of sociodemographic information in test items infrequently supports the clinical diagnosis and perpetuates implicit bias and race-based practices in medical education. Thoughtful inclusion of sociodemographic information in assessment offers an opportunity to address sociostructural determinants of health.