bluuebunny/crossref_metadata_2025 huggingface dataset:
Publication Rate of Abstracts Presented at the Annual APGO/CREOG Meeting
Authors: Nitsche Joshua , Richards Bronwyn , Nae Ana-Maria , Brost Brian
Published: October 2019

PURPOSE:

To determine the publication rate of abstracts presented at the Annual APGO/CREOG Meetings and compare it to rates from other medical education conferences.

BACKGROUND:

Abstract presentations at conferences represent an important means of disseminating scholarly activity. Failure to publish educational research in peer-reviewed journals leads to unnecessary duplication and publication bias.

METHODS:

The following characteristics were recorded from the 2014-2015 APGO/CREOG meeting abstracts: format (oral/poster), award status, type of scholarship (research/educational innovation), methods (quantitative/qualitative), and number of centers involved. Medline and Google Scholar were searched using the names of the first and last author, and key-words from the title and abstract. Chi-square and Fisher’s exact tests were performed to determine which characteristics were associated with publication. The previously reported publication rates from the 2005-2006 Research in Medical Education (RIME) and the Canadian Conference on Medical Education (CCME) conferences were compared to the APGO/CREOG abstracts.

RESULTS:

314 abstracts were reviewed, and 29 (9%) were published. Award winning and oral abstracts, but none of the other characteristics, were associated with higher publication rates. Of the 445 abstracts reviewed from the RIME and CCME conferences 141 (31%) were published, which is a significantly higher rate than those from the APGO/CREOG meetings (p>0.05).

DISCUSSION:

Award winning and oral abstracts were more likely to be published. The rate of publication for abstract presented at APGO/CREOG meetings is notably lower than other conferences. APGO/CREOG should consider ways to increase the publication rate which would potentially enhance the reputation of both the presenters and the Annual Meeting.
“I’d Like to Thank the Academy”… Reflections on Our Inaugural Fellows Academy
Authors: Ratan Rini
Published: October 2019

PURPOSE:

To create a department-wide Fellows Academy to provide senior trainees with an inclusive educational forum, inter-divisional mentorship, networking opportunities and wellness activities.

BACKGROUND:

Fellows in the final stages of training can often become siloed within divisions as they narrow their scope of practice. We created a Fellows Academy to bring together fellows across sub-specialties to discuss common issues as they prepare for independent practice and to enhance a broader sense of community within our department.

METHODS:

We conducted an initial needs assessment survey to determine interest, meeting frequency, and topics of interest. In response, we planned three talks for the year - one on malpractice and one about preparing for a job interview - both requested by 80% of respondents. We also included a joint wellness session with residents about writing a condolence letter to a patient or her family. Fellows evaluated each individual session as well as the overall program.

RESULTS:

48% of fellows completed the needs assessment. 70% felt that a Fellows Academy would be beneficial to their training and 30% were unsure. Evaluations of the individual events were extremely positive. All three sessions received a mean rating 5.0 out of 5.0. Representative comments included, “thanks for organizing this was a great and under-addressed topic” and “moving

DISCUSSION:

Helpful exercise. At the conclusion of the academic year, 100% of respondents felt that the Fellows Academy should be continued.
Incorporating a Resident-Driven Quality Improvement Process Change Through a Lean Transformation of Post-Partum Hemorrhage (PPH) Care
Authors: LaRue Sara , Wood Sara
Published: October 2019

PURPOSE:

To investigate a resident-driven quality improvement lean event to improve satisfaction in PPH management.

BACKGROUND:

Interdisciplinary PPH response strategies are recommended as standard of care. OBGYN resident perceptions regarding PPH management prompted an interprofessional quality improvement lean event to create a systems process change on the post-partum unit.

METHODS:

This was a pre-/post-intervention study evaluating the impact of a lean event that created new hemorrhage protocols (intervention) on postpartum units including: medication safety bundle, assigned/clarified roles for providers, and a streamlined communication process. The survey queried respondents regarding team communication, access to uterotonics and analgesia, and perception of overall patient safety during PPH. It was administered to resident physicians and post-partum nurses prior to the system changes and at 6 and 12-month intervals. These results were compared using nonparametric analyses.

RESULTS:

Participants included 15 residents and 16 nurses. Pre-intervention, there was a significant difference in the overall perception of safety when comparing resident and nurse response (p=0.0495) with residents perceiving a less safe environment. Post-intervention, overall satisfaction among the 2 groups was improved at the 6 & 12 month intervals (p<0.05) without discrepancy between the groups. Nurse results demonstrated significantly increased satisfaction with team communication and IV access protocols (p<0.05).

DISCUSSION:

Resident led quality improvement events can result in improved satisfaction of interprofessional team members in PPH care with improvements maintained over 12 months. Reaching a shared perception and mental model between nursing and residents in the care of PPH can further be studied from the patient’s perspective.
Let’s All Have Big Fun on the Bayou: Exploring Gender Differences in Year-End Faculty Evaluations
Authors: Wagoner Krista , Dempsey Angela , Savage Ashlyn , Johnson Donna , Carter Jessica
Published: October 2019

PURPOSE:

Evaluate how female and male faculty score themselves on self-evaluations compared to each other and the Chairperson.

BACKGROUND:

For decades, women have been proportionately represented among ob/gyn residency graduates. However, male ob/gyn faculty are disproportionately represented among leadership positions and rank of professor and male salaries remain higher. Advancement and salaries are often based on evaluations.

METHODS:

We analyzed de-identified departmental data from 2015-2018, comparing the mean self-evaluation score (range 1-5) for female and male faculty and the difference between self and Chair rating for patient care, education and research. Continuous variables were analyzed using student t-tests.

RESULTS:

The mean number of female and male faculty during the study period was 16 and 15 respectively. The rank of female and male faculty were 69% and 47% assistant, 31% and 20% associate and 0% and 33% professors, respectively. Self-ratings for women and men were 4.1 vs. 4.5 (p=0.04) for patient care, 3.8 vs. 4.3 (p<0.001) for education, and 3.6 vs 3.8 (p=NS) for research. Compared to the Chair rating, the mean difference for female and male self-evaluation was similar in patient care (0.72 vs. 0.53, p=NS) and research (0.22 vs. 0.25 p=NS) but differed in education (0.9 vs. 0.5 p<0.01).

DISCUSSION:

Faculty self-evaluation differed between women and men; women consistently rated themselves lower, with significant discrepancies in patient care and education. Chair ratings were comparable, but were higher for females in education. The cause and impact of this gender difference in faculty evaluation merits further study.
Outcomes of a Transgender Care Training Program in Obstetrics and Gynecology Resident Education
Authors: Tappy Erryn , Katler Quinton , Marfori Cherie
Published: October 2019

PURPOSE:

We sought to evaluate outcomes of an Obstetrics and Gynecology (OB/GYN) resident education program on transgender health.

BACKGROUND:

OB/GYNs are often frontline providers for the transgender community, as patients may first present to an OB/GYN with symptoms of gender dysphoria or postoperative care needs and complications. Both the American College of Obstetricians and Gynecologists (ACOG) and the Council on Resident Education in Obstetrics and Gynecology (CREOG) have developed key areas of competency pertaining to the care of transgender patients by OB/GYNS. To date, standardized educational curriculums on these competency areas are not available.

METHODS:

Residents at our institution completed a 2.5-hour training on transgender health comprised of a standardized patient interaction, debriefing session, and didactic session led by an expert on transgender gynecological care. A 42 item pre- and post-training survey evaluated participant demographics, a validated transphobia questionnaire, medical knowledge of transgender care and preparedness to provide transgender care.

RESULTS:

Eighteen residents and medical students completed the training. The average pre- and post-training knowledge assessments scores significantly improved from 74.8% to 88.9%, (p<0.001). Specifically, knowledge of transgender health disparities, professional guidelines, and management of abnormal uterine bleeding all significantly improved. Baseline transphobia scores were low and did not significantly change. Residents felt more prepared to collect a transgender focused medical history, provide referrals, and access additional educational resources.

DISCUSSION:

Our training improved residents’ knowledge and preparedness to provide a variety of aspects of transgender care. This training was feasible, reproducible and positively received by the resident participants.
Targeted Interventions to Improve Resident Well-Being
Authors: Brolinson Marja , D'Angelo Karen , Hommema Laurie , Auciello Stephen
Published: October 2019

PURPOSE:

To quantify and compare physician well-being and incidence of burnout across residency programs at our institution, emphasizing program-specific and resident-driven interventions.

BACKGROUND:

As the national conversation regarding physician well-being evolves, the importance of addressing physician burnout has come to the forefront. Our institution identified moderate levels of burnout across all residency programs, and thus initiated institution-wide efforts. Literature suggests utilizing organization-wide and targeted interventions together has the most significant impact on improving well-being and reducing burnout.

METHODS:

A Modified Maslach Burnout Inventory (MBI) survey is distributed annually to all residents at our institution. Results from 2015-2018 were analyzed to track changes in burnout scores. All residents participated in institution-wide interventions. Some departments initiated additional resident-determined program-specific interventions.

RESULTS:

Mean MBI scores qualified for moderate burnout for all programs across all years. Most programs utilizing institution-wide interventions demonstrated no change in burnout scores; while some, specifically OB/GYN, saw a statistically significant increase in burnout scores (p<0.001). Departments with program-specific interventions demonstrated decreased scores during the same time period.

DISCUSSION:

Residency programs utilizing targeted interventions demonstrated marked improvement in burnout scores. Amongst those without targeted interventions, OB/GYN demonstrated the largest increase in burnout, suggesting differing etiologies of burnout for individual programs, with OB/GYN being uniquely susceptible. We plan to combat this by utilizing a guided focus group of OB/GYN residents to identify drivers of burnout and specific interventions addressing these factors, using the Mayo Well-Being Index to track anticipated improvement. Continued work in evidence-based strategies addressing the challenge of burnout will ultimately produce more engaged physicians.
Too Many Learners? Do Students Belong in Resident Continuity Clinics?
Authors: Chaalan Tina , Landis-Lewis Deborah , O’Connor Kelly , Popp Bryan , Hammoud Maya , Mowers Erika
Published: October 2019

PURPOSE:

Determine the prevalence of medical students in OBGYN resident continuity clinics and describe effects on the learning environment when students and residents work together in this setting.

BACKGROUND:

Patient continuity is an ACGME requirement often fulfilled through a resident run continuity clinic. It’s unknown how frequently students rotate in these clinics, or how multiple levels of learners influence each other.

METHODS:

We surveyed OBGYN program managers using a national listserv. Resident and student surveys were based on a Likert scale and sent to all OBGYN residents and students that rotated at our institution from 2016-2018.

RESULTS:

Program managers responded from 45 programs and 75.6% scheduled students in resident continuity clinics. Our response rates were 79/116 (68.1%) for students and 21/24 (87.5%) for residents. A one-sample Wilcoxon signed rank test was used to test the hypothesis that the typical response on the five-level Likert scale was “Agree” or “Strongly Agree.” Of medical students, 88.6% stated that they agreed or strongly agreed they enjoyed working with residents (p<0.001) and 60.8% stated they agreed or strongly agreed residents were effective teachers (p<0.001). Among residents, 52.4% agreed or strongly agreed that they enjoyed working with students (p<0.001). However, 61.9% said they agreed or strongly agreed they were too busy to be effective teachers (p<0.001).

DISCUSSION:

Many institutions have students rotate in resident continuity clinics. Residents and students have positive views regarding their interactions. Although students were satisfied, residents expressed concerns about their ability to be effective teachers given clinical demands. Our results highlight the importance of developing resident teaching skills.
An Introduction to the Medical Management of Obesity in Women's Health and the Management of the Post-Bariatric Surgery Patient During Pregnancy
Authors: Cook James
Published: October 2019

PROBLEM:

Medical students lack knowledge about the effects of bariatric surgery on pregnancy and medical management of obesity related to women's health. Additionally, there is bias toward obese patients among clinicians and learners.

INTERVENTION:

We designed a flipped classroom learning experience focused on teaching medical students about the impact and management of obesity and bariatric surgery on pregnancy and women’s health, using pre-reading and clinical vignettes. Students take the Implicit Attitude Test (IAT) before the seminar and are asked to read two review articles; an ACOG Practice Bulletin and Endocrine Society Practice guideline. During a 60-minute, in-person seminar students first work in small groups to discuss clinical vignettes and answer questions/design treatment plans, and then discuss their results on the IAT and how bias may affect patient care. Faculty preceptors oversee the work and lead discussion.

CONTEXT:

Occurs as part of third-year ob-gyn clerkship curriculum.

OUTCOME/LESSONS LEARNED:

Our pilot application of this educational experience measured basic knowledge about obesity and bariatric surgery and their impacts on pregnancy and women’s health. Our preliminary results were reassuring, albeit a very small sample size of 11, showed an improvement in pre and posttest quizzes, with an overall improvement from 53% correct to 84% correct. Our study utilized a cross over design with testing to reduce bias. The assessment of students’ feelings about the seminar's discussion regarding bias was positive with over 90% of respondents reporting they either strongly agreed or agreed the discussion of bias was useful to them as medical students.
Implementation and Feasibility of a Student/Resident Mentorship Program and its Impact on Student Satisfaction and Clerkship Evaluation
Authors: Farez Rahmouna , Kaljo Kristina
Published: October 2019

OBJECTIVE:

We implemented a resident/student mentorship program during the 3rd-year, ob-gyn clerkship. We studied implementation and feasibility and evaluated impact on student satisfaction and students’ evaluations of resident teaching.

METHODS:

In this pilot, prospective cohort study, students at one of three sites were paired with a resident mentor. Students spent at least 4 half days with their mentors, and mentors were to review an H&P, observe a gynecologic exam, and provide feedback. An online survey was used to determine the number of mentor pair meetings and to obtain feedback. We compared end-of clerkship student evaluations of the rotation and of residents (mentor site v. others). Currently, residents are rated as educators at a mean of 3.85 out of 6 (SD 0.99). To detect a mean difference of 1.0 or greater, with power of 0.9, we needed a sample size of at least 10 in each group.

RESULTS:

Between June and October of 2018, 30 students rotated at the mentor program site, and 68 students rotated at the other two sites. Of the students in the mentor site, we received 17 survey responses. On average students reported 2.5 meetings (range 0-5). Written comments were overall positive but also highlighted challenges in execution of the program. Students rated residents more highly as educators at the mentor site than the non-mentor sites (4.49, SD 0.72 vs. 4.35, SD 0.76, p=0.39).

CONCLUSION:

We conclude a resident/student mentorship program is feasible and may result in higher teaching evaluations of residents.
Does a Problem Based Curriculum Enhance Knowledge of CREOG Objectives in an Obstetrics and Gynecology Residency Program?
Authors: Jean-Baptiste Stephanie
Published: October 2019

PROBLEM:

The Council on Resident Education in Obstetrics and Gynecology (CREOG) has set forth educational objectives to be met by the completion of a resident’s four-year training. Many residency programs are challenged with creating a curriculum that encompasses the breadth of knowledge expected to be attained by our residents. Problem based learning (PBL) has been shown to benefit undergraduate medical education as evidenced by a higher retention of material and greater student satisfaction; however, little is known about incorporating this method of learning into an obstetrics and gynecology resident education program.

INTERVENTION:

A structured approach to reviewing CREOG topics was compared utilizing a weekly PBL curriculum followed by a weekly topic curriculum consisting of assigned topic readings.

CONTEXT:

A comparison of weekly PBL versus a weekly topic based curriculum was analyzed evaluating resident performance on biweekly subject quizzes, resident satisfaction, the number of self-study hours, and the number of group study hours per week.

OUTCOME/LESSONS LEARNED:

There was no significant difference in resident performance on subject quizzes, number of self-study hours, or the number of group study hours per week between PBL versus weekly topics. Residents expressed overall satisfaction with weekly topic readings over the PBL approach, however, felt both methods were helpful in providing structured study guidance for the week. This study suggests that providing weekly reading topics on essential CREOG objectives helps provide guidance for residents to review essential topics throughout the year. The effect of long term learning between the two curriculums remains to be explored.
Needs Assessment for Lower Urinary Tract Injury Curriculum for Female Pelvic Medicine and Reconstructive Surgery (FPMRS) Fellowships
Authors: Mueller Margaret
Published: October 2019

OBJECTIVE:

Evaluation and management of lower urinary tract injuries (LUTI) are program requirements for FPMRS fellowship. We will determine level and types of training ACGME-accredited programs utilize to teach about LUTI.

METHODS:

Two surveys conducted among LUTI Curriculum from Program Directors (PDs) and fellows. Survey construction occurred through expert review, cognitive interviews, and pilot testing. Academic FPMRS surgeons vetted the surveys. Modified Delphi process used to finalize surveys. Surveys included demographics, questions assessing current education of LUTI, and competence among graduating fellows. IRB exempt. ABOG distributed electronic survey links to graduating fellows and PDs from 58 ACGME-accredited FPMRS programs.

RESULTS:

Response rate was 69%. 34 FPMRS graduating fellows (71%) and 39 PDs (67%) completed surveys. Most held primary certification in OB/GYN (100% and 85%) with remainder having primary certification in urology. Both groups responded LUTI curriculum was important to FPMRS training. Majority of PDs utilize combination of didactics and hands-on learning (60% and 71%). Only 40% and 30% incorporate LUTI simulation curricula. Graduates report low procedure numbers to evaluate/manage LUT complications. Only 15% of graduates perform greater than 2 ureteral re-implantations. 44% graduate have no minimally invasive abdominal vesico-vaginal fistula repairs. Majority of fellows reported feeling prepared to evaluate LUTI, but nearly 1/3 feel unprepared to independently manage LUTI.

CONCLUSION:

FPMRS PDs and fellows agree LUTI curricula is important. However, most programs utilize only didactics and hands-on learning in the OR with extremely low volume, leading to decreased proficiency. Simulation is a possible solution.
Mentoring for Success in an OB/Gyn Residency Program
Authors: Stonehocker Jody , Espey Eve , Learman Lee
Published: October 2019

PROBLEM:

The UNM OB/Gyn residency program has never implemented a formal mentoring program. Each resident was asked to choose a mentor during their intern year, but no expectations were established or accountability provided for this relationship. Because interns were asked to choose their mentors, the same small pool of mentors was repeatedly chosen and caused mentor fatigue. Struggling residents found it difficult to receive the mentoring they required. Excelling residents often had minimal contact with their mentors.

INTERVENTION:

An evidenced-based formal mentoring program was implemented in March 2018. This includes group mentoring for the first 18 months of residency and individual mentors for the remaining 2.5 years. Mentorship pairs sign a formal mentorship agreement, develop specific goals and objectives to achieve prior to their next meeting, and give written feedback on their relationship. Group mentoring covers a reading curriculum on: Transitioning from student to doctor (September), Work/Life balance (December), Discrimination in medicine (March), Coping with poor patient outcomes (June).

CONTEXT:

Faculty have increasing clinical productivity demands and often do not have time to meet with mentees. Residents must maintain an 80 hour work week. In light of these time constraints we conduct group mentoring and mentor/mentee pair meetings during the usual Grand Rounds hour once each quarter. As the Department develops a faculty compensation plan, these meetings will earn EVUs.

OUTCOME/LESSONS LEARNED:

Initial satisfaction has been high. The first group of R2s have chosen their personal mentors and includes more subspecialists. Administrative support is needed to track completion of required tasks.
Efficacy of a Flipped Classroom Obstetrics Didactics Module in the OBGYN Clerkship
Authors: Tran Susan
Published: October 2019

OBJECTIVE:

To contemporize the OBGYN medical student learning experience, flipped classroom/team-based learning models were implemented starting with select obstetrics topics.

METHODS:

Preeclampsia and preterm premature rupture of membranes were taught using a flipped classroom/team-based learning model. Remainder of clerkship curriculum was taught using traditional didactics. Pre-work included corresponding APGO Educational videos and individual completion of corresponding APGO Teaching Case questions. In class, students worked through Teaching Case questions. Test of change was evaluated over 4 clerkship rotations (between 8/20/18–12/14/18). Using two-tailed t-tests, mean clerkship didactics satisfaction scores (scored 1–5) and final exam scores (percent correct) were evaluated from these 4 study groups, and compared to the 4 rotations from the same time of year (between 8/21/17–12/15/17) prior to implementation of the flipped classroom, to control for differences in student satisfaction and exam performance that may be affected by the time of year in which student completes OBGYN clerkship.

RESULTS:

There were 54 students in test of change study group compared to 44 in control group. The mean final exam scores were 70.0% (study group) and 74.9% (control group) (p<.05). The mean student satisfaction scores were 4.92 in the study group and 4.57 in the control group (p=0.07).

CONCLUSION:

Implementation of a flipped classroom was associated with lower mean final exam score compared to utilization of traditional didactics model. Student satisfaction scores were higher in the flipped classroom group, but did not reach statistical significance.
CAST (Cultural Awareness Through Student Theater): A Workshop to Improve Resident Communication Skills With Patients from Diverse Backgrounds
Authors: Valthaty Rebekah , Kuo Yen Hong , Schwartzberg Paul
Published: October 2019

PROBLEM:

ACGME requires cultural competency training. Yet, trainees often do not receive formal training in the setting of cultural competency. We propose to apply the use of medical students as simulated patients to teach these skills.

INTERVENTION:

At orientation our interns participated in a workshop involving case-based scenarios created to include culturally sensitive topics simulated by medical students.

CONTEXT:

Small group sessions included 5-6 interns, a faculty member, student actor and expert. Immediate feedback was given. Each intern completed a brief pre-and post- survey and a reflection essay. A checklist created using the ETHNIC model was used. Medical students and faculty attended a didactic training session, and faculty received the cases and learning objectives prior to the workshop.

OUTCOME/LESSONS LEARNED:

Statistically significant improvements were noted in familiarity with cultural competency (P = 0.0001), comfort with medical needs of patients from different cultural backgrounds (p = 0.0016), understanding individual’s cultural background can be a health determinant (p = 0.0001), understanding how differences between cultures and personal healthcare practices can affect the perception of care (p=0.001), importance of negotiating a mutually acceptable treatment plan that may differ based on the patient’s cultural background (p = 0.0001), and understanding that it is the physician’s job to create a culturally sensitive environment (p = 0.0001). No statistically significant differences were noted in understanding how a patient explains/perceives illness or importance of collaboration with patient's other health providers. These outcomes will be used to improve the case-based scenarios.
Implementation of a Smartphone App to Measure and Manage Anxiety in Undergraduate Clinical Nursing Students
Authors: Peters Anya Bostian , Kellogg Marni , Zhang Yuan
Published: October 2019

Various causes exist for nursing student anxiety in the clinical setting. There is a need for further intervention research that may be effective to reduce student anxiety related to clinical. The purpose of this pilot research study was to measure and manage anxiety for nursing students in the clinical area with the assistance of a smartphone app. The usefulness of the app was evaluated by means of a focus group.
A guide to newborn assessment
Authors: Scannell Meredith , Puka-Beals Emma
Published: October 2019

Nurses who work in areas with infants need to be comfortable with conducting a newborn exam because they may be the first to identify a risk or condition that requires intervention.
Does Repeated Painful Stimuli Change Cerebral Near-Infrared Spectroscopy Response in Healthy, Term, Large for Gestational Age Newborns?
Authors: Ozdemir Hulya , Bilgen Hulya , Gokulu Gamze , Memisoglu Asli , Ozek Eren
Published: October 2019

Objective:

The objective of this study was to evaluate the effect of repeated painful stimuli on short-term pain response in healthy, term, large for gestational age newborns by measuring the regional cerebral oxygen saturation (rScO2), and behavioral and physiological responses.

Methods:

We compared term large for gestational age infants who received repeated painful stimuli (study group) with term, appropriate for gestational age infants (control group). A pulse oximeter and a near-infrared spectroscopy probe were connected to babies during the study period, and the responses of the babies were recorded by video, from which the crying time and the Neonatal Infant Pain Scale were obtained. The heart rate, peripheral oxygen saturation (SpO2), and rScO2 data were sampled every 1 second and exported to a personal computer via digital output during the study period. The maximum heart rate, the minimum SpO2, and peak, baseline, and mean rScO2 measurements following skin puncture were recorded. Data were compared within 1 group and between the 2 groups.

Results:

After the heel prick, crying time (P<0.001) and Neonatal Infant Pain Scale scores (P=0.024) increased, and SpO2 levels decreased significantly (P=0.012) in the study group versus the control group. Although mean rScO2 increased significantly within 1 group (P<0.001), it was not significant between the 2 groups. The percent change in rScO2 was greater in the study group (5.2 [2.5 to 9.3]) compared with the control group (2.8 [1.1 to 8.2], P=0.037).

Conclusion:

We showed that rScO2 values changed significantly within the first few days of life in babies who received more painful stimuli compared with the control group, similar to behavioral and physiological responses.
Use of Asynchronous Video Interviews for Selecting Obstetrics and Gynecology Residents
Authors: Breitkopf Daniel M. , Green Isabel C. , Hopkins Matthew R. , Torbenson Vanessa E. , Camp Christopher L. , Turner Norman S.
Published: October 2019

OBJECTIVE:

To assess the effect of using of asynchronous video interviewing as a screening tool for obstetrics and gynecology residency selection.

METHODS:

This project was part of a quality-improvement effort to enhance the resident application process. Applications to a single obstetrics and gynecology residency program were scored using standardized criteria. In the 2018 Match, top-scored applicants were invited to in-person interviews, and second-tier applicants were asked to complete a three-question asynchronous video interview. Video interviews were scored and used to invite the remaining applicants for in-person interviews. In the 2019 Match, video interviewing was expanded to all applicants with top application scores, and the video score was used to determine in-person interview invitations. Applicants for 2019 were surveyed on their views regarding video interviewing.

RESULTS:

Half of the candidates interviewed in person in the 2018 season were screened by the video interview process compared with 82% in the 2019 season. The mean in-person interview score increased from 59.0 in 2017, before screening with asynchronous video interviews, to 62.2 in 2018 (effect size 0.50; 95% CI 0.09–0.90) In 2018, a nonsignificant correlation was seen between the video interview score and rank list percentile (r=0.22, P=.15, n=27) and in-person interview score (r=0.18, P=.12, n=46). United States Medical Licensing Examination step 1 and 2 scores were not correlated with video interview scores in either season. Most (58%) candidates indicated that the asynchronous video interview was an effective way to tell their story; however, only 42% were comfortable with the interview process.

CONCLUSION:

Video interviewing may have promise as a tool for program directors to use to select candidates from a competitive applicant pool by measuring important noncognitive skills. Acceptance by obstetrics and gynecology applicants was mixed.
Chemoprophylaxis for the Hip Fracture Patient: A Comparison of Warfarin and Low-Molecular-Weight Heparin
Authors: Trivedi Nikunj N. , Sivasundaram Lakshmanan , Wang Christopher , Kim Chang Y. , Buser Zorica , Wang Jeffrey C. , Ochenjele George
Published: October 2019

Objective:

To compare the rates of deep venous thrombosis (DVT), rates of pulmonary embolus (PE), and complication profiles of warfarin and low-molecular-weight heparin (LMWH) in patients undergoing operative fixation of hip fractures.

Design:

Retrospective cohort study.

Setting:

Insurance-based database of more than 22 million patient records.

Patients:

Adult hip fracture patients who were treated operatively and received chemoprophylaxis from 2007 to 2016. A total of 7594 patients met inclusion criteria and were available for final analysis.

Intervention:

Pharmacological anticoagulation with warfarin or LMWH to prevent postoperative venous thromboembolism after hip fracture surgery.

Main Outcome Measures:

Development of DVT or PE within 30 and 90 days of surgery.

Results:

Patients prescribed warfarin had higher rates of DVT and PE compared with those prescribed LMWH. Patients on warfarin were more likely to develop a postoperative hematoma and to be readmitted within 30 and 90 days compared with those on LMWH. Patients in both groups had similar rates of total complications.

Conclusions:

Patients prescribed warfarin after hip fractures had higher rates of DVT and PE compared with those prescribed LMWH, although both agents had similar complication profiles.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Adrenal tumours: open surgery versus minimally invasive surgery
Authors: Fiori Cristian , Checcucci Enrico , Amparore Daniele , Cattaneo Giovanni , Manfredi Matteo , Porpiglia Francesco
Published: October 2019

Purpose of review

The aim of this article is to focus on state-of-the-art minimally invasive adrenalectomy (MIA) and the most recent role of open adrenalectomy for adrenal tumours, respect to MIA and open adrenalectomy for adrenocortical cancer (ACC).

Recent findings

The laparoscopic (both transperitoneal and retroperitoneal) approach is the first-choice treatment in cases of small-to-medium benign adrenal tumours. This approach is feasible and well tolerated even for larger lesions without radiological signs of malignancy. Robotic adrenalectomy has recently increased in popularity, although the results appear to be fully comparable with those of laparoscopy. Open approach is the keystone of ACC surgery, especially when neighbour tissues, organs, or vessels are involved. Recent evidence suggests caution in treating localized ACC with laparoscopy, because of the higher rate of local or peritoneal recurrence, and shorter recurrence-free survival rates with respect to open adrenalectomy.

MIA has progressively replaced the traditional open approach and plays a complementary role in the treatment of adrenal tumour. It is the first option for benign lesions, whereas open adrenalectomy is a cornerstone treatment for ACC. The overlap of indications for laparoscopic adrenalectomy and open adrenalectomy is today confined to the treatment of organ-confined adrenal cancer, in which the role of laparoscopic surgery is far from being clearly defined.
Does preventive oophorectomy increase the risk of depression in BRCA mutation carriers?
Authors: Kotsopoulos Joanne , Gronwald Jacek , Lubinski Jan , McCuaig Jeanna , Lynch Henry T. , Neuhausen Susan L. , Foulkes William D. , Weitzel Jeffrey N. , Senter Leigha , Tung Nadine , Eng Charis , Karlan Beth , Sun Ping , Narod Steven A.
Published: October 2019

Objective:

BRCA mutation carriers are advised to undergo bilateral salpingo-oophorectomy to prevent ovarian cancer. The abrupt hormonal withdrawal associated with early surgical menopause has been shown to increase the risk of depression and anxiety among women in the general population. The impact in women with a BRCA1 or BRCA2 mutation is not known.

Methods:

We undertook a matched prospective study of BRCA mutation carriers to evaluate the impact of oophorectomy on self-reported initiation of antidepressant use. We identified women with no personal history of cancer or depression and prospectively evaluated the frequency of self-reported medication use after surgery. Each exposed participant (oophorectomy) was randomly matched to a control participant (no oophorectomy) according to year of birth (within 3 years), BRCA mutation type (BRCA1 or BRCA2), and country of residence (Canada, United States, Poland). A total of 506 matched sets were included. We estimated the odds ratio (OR) and 95% confidence intervals (CIs) of antidepressant use (ever/never) following preventive oophorectomy in the entire study population and stratified by age at oophorectomy and by use of hormone therapy.

Results:

Oophorectomy was not associated with more frequent antidepressant use among BRCA mutation carriers (OR = 0.46; 95% CI 0.22-0.96). We observed reductions in the odds of antidepressant medication use among women who underwent oophorectomy before the age of 50 years (OR = 0.33; 95% CI 0.14-0.78) and among those who initiated hormone therapy use after oophorectomy (OR = 0.35; 95% CI 0.14-0.90). Findings were similar when the analysis was based on self-reported depression (rather than antidepressant use).

Conclusions:

Although based on a small number of women, these findings suggest that oophorectomy does not increase psychological distress among women at an elevated risk of ovarian cancer.
Contribution of Real-Time Xpert MTB/RIF Testing to Establishing Early Diagnosis of Pediatric Extrapulmonary Tuberculosis in a Nonendemic Setting
Authors: Mijović Hana , Al-Nasser Yossef , Al-Rawahi Ghada N. , Roberts Ashley D.
Published: October 2019

Microbiologic confirmation of pediatric extrapulmonary tuberculosis remains challenging, leading to diagnostic delays. In our retrospective case series, real-time molecular testing (Xpert MTB/RIF) on respiratory and extrapulmonary specimens resulted in a more rapid diagnosis of extrapulmonary tuberculosis in a nonendemic, high resource setting.
β-3 adrenergic receptor gene polymorphisms are associated with gestational diabetes mellitus in a Chinese population
Authors: Jia He , Pan Yuan , Wang Yun , Yin Feng-Ling , Xu Na
Published: October 2019

Increasing studies demonstrated that genetic susceptibility attributes to the development of gestational diabetes mellitus (GDM). The polymorphisms of the β-3 adrenergic receptor(β-3AR) gene have been found to be of great importance in bodyweight elevation and dyslipidaemias. We aimed to determine the influence of β-3AR polymorphisms on the GDM risk. Thus, we performed a case-control study including 136 GDM cases and 138 controls to evaluate the relation between the rs201607471 and susceptibility to GDM. Likelihood ratios X

2
analysis showed the distribution of the genotype frequency (rs201607471 in β-3AR gene) was accorded with the Hardy-Weinberg genetic equilibrium. Although no significant association between rs201607471 alleles and GDM susceptibility (Chi-square test, P > .05), we observed that β-3AR gene rs201607471 CT genotype was significantly prevalent in GDM (Chi-square test, P < .05). Moreover, we observed that β-3AR gene rs201607471 C > T was significantly associated with an increased risk of GDM using the recessive model (CC vs CT/TT: P = .026) and the additive model (CC vs CT vs TT: P = .038). These data indicate that β-3AR rs201607471 may be a helpful susceptibility marker for GDM in Chinese pregnant women.
Increased Elabela levels in the acute ST segment elevation myocardial infarction patients
Authors: Dönmez Yurdaer , Acele Armağan
Published: October 2019

Elabela is a bioactive peptide and a part of Apelinergic system. Elabela has an important role in the early embryonic stages. Elabela's beneficial effects in cardiovascular system were shown in some animal models or in vitro studies. Lately, some investigational studies in humans are started to be seen in literature. Our aims were to investigate serum Elabela levels in the first day of ST segment elevation myocardial infarction (STEMI), to compare with healthy controls, and to see if there is a correlation between other cardiac biomarkers in humans.

The study was planned as cross-sectional. The patients group had 124 STEMI subjects. They were grouped as inferior (n = 59) and anterior myocardial infarction (n = 65) groups, and compared with the healthy control population (n = 77). Routine blood tests and serum Elabela levels were measured. Transthoracic echocardiography performed to all subjects.

Frequency of diabetes mellitus, hypertension, smoking, and hyperlipidemia in both STEMI groups were significantly higher than control subjects. Glucose, high density lipoprotein (HDL) cholesterol, triglyceride, high sensitive C reactive protein (Hs-CRP), troponin I, N-terminal brain natriuretic peptide (NT-ProBNP), and Elabela levels were significantly higher in both STEMI groups. Other laboratory parameters were similar. Group 2 and 3 had significantly lower left ventricular ejection fraction (LVEF) than group 1. Group 3 had also significantly lower LVEF than group 2. There was a positive but moderate correlation between Elabela, troponin I, and NT-ProBNP. Elabela was negatively correlated with LVEF. This correlation was also moderate.

We showed increased Elabela levels in STEMI patients in this study. Also, we observed a moderate positive correlation between troponin I, NT-ProBNP, and Elabela.
Traumatic posterior atlantooccipital dislocation combined with type II dens fracture and C1 anterior arch fracture
Authors: Chang Dong-Gune , Park Jong-Beom , Cho Yoon Joo , Kim Gang-Un
Published: October 2019

Rationale:

Traumatic AOD is rare but highly associated with upper cervical spine injuries. We found no references in the literature of traumatic posterior atlantooccipital dislocation (AOD) combined with type II dens fracture (Anderson-D’Alonzo classification) and C1 anterior arch fracture.

Patient concerns:

The first case was a 93-year-old male patient who was admitted to the Emergency Department complaining of incomplete quadriplegia after a fall from a height. The second was a 53-year-old male patient who visited the emergency department complaining of posterior neck pain following a high-speed motor vehicle collision.

Diagnosis:

Reconstructed computed tomography (CT) scans clearly demonstrated posterior AOD combined with type II dens fracture and C1 anterior arch fracture. In addition, magnetic resonance imaging (MRI) also revealed type II transverse atlantal ligament injury (Dickman's classification) in the first patient.

Interventions:

The patients chose not to undergo surgery; instead, they were immobilized with a rigid cervical brace.

Outcomes:

The patients were lost to follow-up.

Lessons:

A thorough clinical evaluation and radiologic investigation (CT and MRI) on concomitant upper cervical injuries should be evaluated in traumatic AOD patients.
The ongoing D-lemma of vitamin D supplementation for nonskeletal health and bone health
Authors: Charoenngam Nipith , Shirvani Arash , Holick Michael F.
Published: October 2019

Purpose of review

The goal of this review is to give some perspective on the results and conclusions of three recent randomized controlled vitamin D intervention studies that have challenged the health benefit of vitamin D supplementation for reducing risk for cardiovascular disease, cancer, all-cause mortality and type 2 diabetes and improving bone health.

Recent findings

Vitamin D supplementation to adults who were vitamin D sufficient or insufficient did not reduce risk for developing cardiovascular disease, cancer, type 2 diabetes nor increases bone mineral density (BMD). Patients who were vitamin D deficient with cancer and received vitamin D reduced risk for mortality by 25% and prediabetic adults who were vitamin D deficient and received vitamin D reduced their risk of developing type 2 diabetes by 62%. Older adults receiving 4000 and 10 000 IUs of vitamin D3 daily for 3 years had reduced radial BMD but had no change in either total hip areal bone density or bone strength in the radius and tibia.

Caution is needed when evaluating results and conclusions from randomized controlled trials that investigate health benefits of vitamin D; most studies suggest health benefits when vitamin D supplementation is provided to vitamin D deficient populations and little benefit when given to populations that are vitamin D sufficient/insufficient.
Reconnecting Nurses to Their Passion and Enhancing the Patient and Family Experience
Authors: Sterchi Suzanne , Brooks Sharon , Shilkaitis Mary , Ris Laurel
Published: October 2019

The development of a program to integrate an organization's values and culture, Watson's Caring Theory, and personal motivators resulted in transforming nursing theory into practice and a noted improvement in the patient experience. This article will teach the reader how this was accomplished.
Travel Nurse Onboarding
Authors: Bethel Claire , Olson Susan , Bay Curt , Uyeda Tami , Johnson Karen
Published: October 2019

OBJECTIVE

The purpose of this study was to describe current practices for onboarding travel nurses (TRNs) and identify TRNs' specific onboarding needs.

BACKGROUND

Onboarding must be streamlined and organized for TRNs to provide safe patient care.

METHODS

Cross-sectional descriptive survey was used with 306 TRNs throughout United States who were recruited electronically from a closed social media group page.

RESULTS

The TRNs identified critical information, including unit patient ratios, onboarding schedule 7 to 14 days before travel assignment start, and login IDs/accesses on day 1. Travel nurse onboarding and competency assessment checklists should be specific to the unit/facility where they will work.

CONCLUSION

Findings from this study have the potential to support hospitals in the development of streamlined and tailored TRN onboarding to support regulatory compliance and patient safety as well as realize significant cost savings for TRN onboarding.
AONL Foundation Looks to the Future
Authors: Begley Robyn , Zimmermann Deborah
Published: October 2019

During the 1st half of 2019 the AONL Foundation for Nursing Leadership Research and Education underwent an identity and brand change and adopted a new strategic plan, complete with a new mission and vision, to guide the foundation's work forward toward creating a sustainable research for nursing leadership research and education. This article describes the strategic planning activities and process the AONL Foundation recently undertook and highlights future goals.
Lymphocyte-predominant Esophagitis
Authors: Pittman Meredith E. , Hissong Erika , Katz Philip O. , Yantiss Rhonda K.
Published: October 2019

Lymphocytic esophagitis is a well-known manifestation of Crohn disease among children but is not considered to be an immune-mediated mucositis in adults. We hypothesize that adult-onset lymphocyte-predominant esophagitis is also an immune-mediated inflammatory pattern, the nature of which has been masked by other conditions that feature esophageal lymphocytosis and occur in older patients. We performed this study to consolidate diagnostic criteria for lymphocyte-predominant esophagitis and determine its clinical significance. We identified 61 patients with lymphocyte-rich inflammation in the mid or proximal esophagus, none of whom had another explanation for esophageal lymphocytosis. Affected patients were usually older adults and 72% were women. Most (56%) presented with dysphagia and 34% had eosinophilic esophagitis-like changes with rings, exudates, and/or edematous mucosa and linear furrows. Intraepithelial lymphocytosis was accompanied by mucosal injury featuring edema, basal zone hyperplasia, and scattered dyskeratotic cells. Some cases displayed occasional neutrophils or even superficial microabscesses; eosinophils were consistently infrequent. Most (67%) patients had at least 1 systemic immune-mediated disorder, particularly Crohn disease (30%) and connective tissue diseases (23%); only 1 had mucocutaneous lichen planus. We conclude that mild mucosal lymphocytosis (ie, ≥20 lymphocytes/HPF) alone is a frequent and nonspecific finding; criteria for lymphocyte-predominant esophagitis should include evidence of mucosal injury and allow for more than the occasional neutrophil. When this diagnosis is limited to cases that feature lymphocytosis unattributed to acid reflux, motility disorders, or infection, lymphocyte-predominant esophagitis may represent an immune-mediated disorder with characteristic clinical manifestations and a predilection for middle-aged women.