bluuebunny/crossref_metadata_2025 huggingface dataset:
Bridging Gaps in Access for Youth: Youth Feedback on a Novel Sexual and Reproductive Health Digital Platform [ID: 1377818]
Authors: Sao Saumya , Coleman Jenell , Wang Runzhi
Published: May 2023

INTRODUCTION:

Youth bear a disproportionate burden of sexually transmitted infections (STIs) in the United States. Youth face barriers to STI testing, such as fear of breaches in confidentiality, lack of transportation, and anticipated stigma. Also, youth struggle with knowing when and where to get tested because of a lack of education about sexual and reproductive health (SRH). We sought to obtain feedback from youth about a digital health platform designed to address these barriers.

METHODS:

The Health Belief Model was used to develop a prototype digital health platform that offered interactive SRH education, free STI testing and safe sex products, and an anonymous ask column. Five focus group discussions (IRB approved) were conducted, each lasting 45–60 minutes with five to six youth living in a high-prevalence STI region of Baltimore, Maryland. Thematic analysis was performed.

RESULTS:

Twenty-eight youth (aged 14–19) participated. Three domains emerged: 1) the need for a reliable source of SRH information, 2) approval of the digital health platform, and 3) suggestions for improvement. Youth expressed concerns about the reliability of SRH information they receive from school, peers, and media. Participants preferred to access SRH resources on their phones or other small electronic devices as opposed to laptops or computer screens that may feel more exposed. Additionally, participants desired to access this information for free as that removes barriers of parental approval and financial support.

CONCLUSION:

Overall, youth viewed the digital health platform as an acceptable tool for sexual and reproductive health care education. The platform met their preferences of being free, accessible, and reliable.
Updated Causes of Primary Amenorrhea [ID: 1381195]
Authors: Fowler Kylie , Josephson Rebecca , O'Flynn O'Brien Kate , Pitera Rosabella
Published: May 2023

INTRODUCTION:

Pubertal progression within a normal cadence is an important marker of natal female health. Data regarding causes of primary amenorrhea in a United States' adolescent population have not been published since 1981. We hypothesize that hyperandrogenism/polycystic ovarian syndrome (PCOS) is an increasingly common cause of primary amenorrhea.

METHODS:

A retrospective chart review was performed to identify patients with primary amenorrhea. A total of 1,785 charts were identified, of which 1,052 charts have been reviewed. Patients with hyperandrogenism/PCOS were classified by meeting any recommended diagnostic criteria for PCOS in adolescents or an elevated total or free testosterone based on Tanner staging with all other conditions ruled out. Other diagnoses for primary amenorrhea were classified per the American Society for Reproductive Medicine guidelines.

RESULTS:

Of the 1,052 charts reviewed so far, 263 patients met criteria for primary amenorrhea. Causes in order of prevalence were as follows: 85 hyperandrogenism/PCOS (32.3%), 71 hypothalamic hypogonadism (27%), 36 physiologic delay (13.7%), 19 primary hypogonadism (7.2%), 15 other endocrine causes (5.7%), 8 pituitary (3%), and 4 anatomic (1.5%). Twenty-five (9.5%) patients were unable to be classified. Of the 71 patients with hypothalamic hypogonadism, 27 (38%) had relative energy deficiency in sport (RED-S) making it the most common diagnosis of patients in this categorization.

CONCLUSION:

Polycystic ovarian syndrome/hyperandrogenism and RED-S are among the top three causes of primary amenorrhea. Proposed reasons for the shift in causes of primary amenorrhea over time include increasing obesity rates and metabolic syndrome in adolescents on one hand as well as increasing access to high-level athletics on the other.
Implementing a Virtual Collaborative Behavioral Health Care Program in an Obstetrics and Gynecology Practice [ID: 1376661]
Authors: Moon Khatiya , Alvarado George , Hy Jonathan , McNally Stephanie
Published: May 2023

INTRODUCTION:

More women require behavioral health services than exist psychiatrists to treat them. In order to meet this need, the collaborative care model (CoCM) was proposed in the 1990s to extend the reach of behavioral health services. Relatively little is known about the applicability of the CoCM to obstetrics. We instituted a virtual collaborative behavioral health care program in an obstetrics and gynecology practice in our health system.

METHODS:

This was an IRB-approved retrospective chart review of a collaborative care program using the model initially proposed in the IMPACT study. Patients presenting to an obstetrics and gynecology office were assessed for depression using validated tools (PHQ-9). Women who screened positive were referred to a behavioral health care manager (BHCM) embedded in the practice. The BHCM conducted a behavioral health assessment, provided short-term psychotherapy, coordinated referral to a higher level of care if necessary, maintained a registry of patients, and worked with a supervising psychiatrist who provided medication recommendations. Our primary outcomes were the incidence of screenings completed, the number of contacts with the BHCM, and the number of cases that underwent review by a psychiatrist.

RESULTS:

Between February 2020 and February 2022, 166 women were enrolled in the CoCM out of 213 referred by the obstetrician–gynecologist (78% enrollment rate); participants were enrolled for an average of 177 days. Ninety participants (n=166, 54%) had at least one PHQ-9 completed and 81 participants (n=166, 49%) had at least one GAD-7 completed. One hundred six (n=166, 64%) patients had therapy for an average of five visits. One hundred four (n=166, 63%) participants participated in care coordination. Thirty-four (n=166, 20%) cases were reviewed by a psychiatrist.

CONCLUSION:

Our results indicate the high utilization of collaborative care services in this context, and moderate feasibility with only half of enrolled participants receiving validated assessments. Future studies should examine effectiveness and the components of the model that are most beneficial.
Patient's Perception of Access to Reproductive Health and Family Planning During the COVID-19 Pandemic Quarantine Period [ID: 1372575]
Authors: Caplin Arielle , Eisner Isabel , Foster Hannah , Gutta Sravanthi
Published: May 2023

INTRODUCTION:

The objective of this study was to assess patient perception of access to reproductive health and family planning care during the COVID-19 pandemic quarantine period, at which time routine annual visits were deferred.

METHODS:

Patients aged 18–44 seen at Temple University Hospital for an annual gynecology visit from March 2018 to December 2020 were identified. Pregnant patients, those with a history of permanent sterilization (bilateral tubal ligation, hysterectomy), women who were not heterosexually active, prisoners, non-English or non-Spanish speakers, and those with intellectual disability were excluded. Using a random number generator, 99 eligible patients were randomly selected from this population. Eligible patients were contacted via telephone and verbally consented. If agreeable, these patients were administered a 20-question survey.

RESULTS:

Of 99 patients selected, 27 (27.3%) responded to the telephone survey. 0% of responders felt that they faced barriers to contraceptive care during the quarantine period. Survey responders and nonresponders had no significant differences in age (P=.26), race (P=.50), insurance type (P=.15), gravida (P=.78), parity (P=.10), and number of induced abortions (P=.51). However, nonresponders were significantly more likely to have no-showed a gynecology appointment in 2020 (P<.05).

CONCLUSION:

This study found that patients at Temple University Hospital did not perceive barriers to accessing contraceptive care during the COVID-19 quarantine period. Additionally, the majority of patients felt that contraceptive care was an important reason to have an in-person visit.
Results of a Multidisciplinary Workshop to Reduce Bias and Improve Health Equity for Patients With Limited English Proficiency [ID: 1375774]
Authors: Garrison Etoi , Bey Amita , Jimenez Eleazar , Li Andria , Nettles Arie
Published: May 2023

INTRODUCTION:

Birthing people with limited English proficiency (LEP) often face systemic limitations to care and are at increased risk for disparate birth outcomes due to barriers in patient–provider communication. Patients with LEP are particularly vulnerable to biases and microaggressions that can limit timely health care delivery and the quality of services received. We developed a multidisciplinary curriculum to educate providers about 1) unconscious bias (UCB), 2) barriers to equitable health care delivery for patients with LEP, and 3) use of trained interpreter services to promote patient–provider communication.

METHODS:

We developed a 60-minute workshop for physicians/midwives/nurses (n=75). Surveys were used to assess change in knowledge. Results were evaluated by descriptive statistics, t tests for significance, and thematic analysis. Institutional review board approval was obtained.

RESULTS:

Approximately 75 participants attended the workshop. Thirty-three percent of pre-workshop survey respondents (13/39) had not received cultural competency training within the last 3 years. Approximately 1 in 5 (22%) pre-workshop respondents were unaware of their hospital's interpreter services policy. After a brief didactic presentation, participants identified common microaggressions and barriers to care for patients with LEP. They also developed 15 unique strategies to promote communication via use of trained interpreters when the patient/family initially opt for ad hoc interpretation instead. At workshop completion, 97.1% of participants reported that they will adopt or modify an existing strategy when communicating with LEP patients and families.

CONCLUSION:

Post-workshop survey results suggest that continuing education can be used to address UCB for patients with LEP and promote use of interpreter services to improve patient–provider communication.
Before and After SB8: Obstetrics and Gynecology Residency Application Patterns in Texas [ID: 1353318]
Authors: DiCenzo Natalie , Giglio Marisa
Published: May 2023

INTRODUCTION:

In September 2021, Senate Bill 8 (SB8) banned abortion in Texas around 6 weeks of gestation. This law authorizes members of the public to sue anyone who performs or facilitates an illegal abortion. This study investigates the change in patterns of obstetrics and gynecology residency applications from the application cycle before and after the ban took effect.

METHODS:

Using publicly available data of United States obstetrics and gynecology residency applications via Association of American Medical Colleges Residency Explorer, we calculated the average number of applications submitted to residency programs in Texas before SB8 (2020 cycle) and after (2021 cycle) the law was in effect. We then compared the application patterns in the state of Texas to the average number of applications submitted to other states in the country.

RESULTS:

According to public data, the average number of applications per residency program in the United States increased from 547 to 616, or a net average increase in 69 applications per program, from 2020 to 2021. Comparatively, in the same time period, the average number of applications per program in Texas increased from 565 to 598, or a net average increase of 33. Therefore, the average rate of residency application increase in Texas was half that of the rest of the country.

CONCLUSION:

After the introduction of SB8, there was slower growth in the average number of applications to Texas obstetrics and gynecology residency programs compared to the average across the rest of the country. This could indicate a decreasing number of applicants to states with restrictive abortion laws in place in the future.
Effect of a CME Symposium on the Obstetrician–Gynecologist's Knowledge and Confidence Related to CGM Use in Pregnant Patients [ID: 1368750]
Authors: Larkin Amy , Le Anne , Schrand Julie
Published: May 2023

INTRODUCTION:

We sought to measure the effect of a live symposium at the American College of Obstetricians and Gynecologists followed by enduring on Medscape related to real-time continuous glucose monitoring (rtCGM) use in pregnant patients.

METHODS:

Pre and post questions assessed changes in knowledge and confidence. Absolute differences were calculated for the live activity. For the enduring, completers of all pre and post questions were linked and analyzed.

RESULTS:

There were 61 live participants: 68% were physicians, 3% NPs, 3% pharmacists, and 3% nurses. There was a 21% increase in learners who recognized time in range goals for pregnant patients with diabetes, and a 26% increase in those who reported being very or somewhat confident in using rtCGM in their patients with diabetes (24% less were not confident with this concept). 100% declared the content learned will affect their practice, and 91% reported being committed/very committed to implementing practice changes. There are 3,595 enduring learners to date (October 9, 2022), and 83 completers of all questions by August 30, 2022. 16% of ob-gyn learners improved at recognizing time in range goals for pregnant patients with diabetes. Eighteen percent of ob-gyn learners improved at recognizing the benefit of rtCGM in pregnant patients with diabetes. Thirty-nine percent of ob-gyn learners had increased confidence in using rtCGM in pregnant patients with diabetes for an average confidence shift of +79% among those with increased confidence.

CONCLUSION:

The outcomes gathered in this assessment are a strong indicator that live, in-person CME symposia followed by online enduring is successful at improving knowledge and confidence related to rtCGM use in pregnant patients with diabetes, and possibly promote improvements in clinical practice.
Applicant and Program Director Perceptions Regarding Virtual Interviewing and Signaling [ID: 1373344]
Authors: Schoppen Zachary , Gabbur Nagaraj , Kaufman Leah , Miller Sarah
Published: May 2023

INTRODUCTION:

In 2020, obstetrics and gynecology residency programs switched to a virtual interview format because of the COVID-19 pandemic. Most programs have continued to conduct virtual interviews. In 2022, program signaling was introduced to allow candidates applying to obstetrics and gynecology residencies to indicate interest in specific programs. The objective of this study is to survey medical student residency applicants and program directors about their perceptions of the process.

METHODS:

Education for All (EFA) developed a validated survey assessing student and residency program director perceptions. This survey was distributed online to all residency applicants and program directors who registered for the 2022 EFA Residency Fair.

RESULTS:

Five hundred six obstetrics and gynecology residency applicants and 33 program directors responded. 37% applicants indicated that virtual interviews would probably provide enough information to create a rank list, but 36% were not sure. 37% of students and 50% of residency programs indicated the process should continue to be virtual. Ninety-one percent of students indicated they would “definitely” use signaling, and 66% of program directors said signaling “might or might not” improve the application process. In a free-text section, many applicants expressed concern with the virtual interview process.

CONCLUSION:

Fifty percent of residency programs and the majority of residency applicants are unsure if interviews should continue to be virtual. Nearly all candidates planned to use program signaling, but the majority of program directors were unsure if this would improve the application process. Further study is necessary to determine whether program signaling and virtual interviews should be continued in the future.
Did the Initiation of ACOG Surgical Curriculum Affect Accuracy of Videos Published on YouTube for Ob-Gyn Resident Education? [ID: 1374093]
Authors: Foncham Juanita , Francis Antonia , Kayaalp Emre , Mcilvaine Jamie
Published: May 2023

INTRODUCTION:

The purpose of this study was to assess the accuracy of open-access online obstetrics and gynecology procedural videos to the ACOG Surgical Curriculum in Obstetrics and Gynecology (SCOG) and its educational value. YouTube is commonly used as an easily accessible resource for education and surgical preparation. There is no current research that evaluates instructional videos for educational usefulness across multiple obstetric and gynecologic procedures. Given the rigorous workload of residents and the fact that they are already relying on these videos, despite the lack of known quality control, this study was designed to develop an efficient way to determine whether any given video can deliver quality information that is useful for building surgical skills.

METHODS:

The SCOG topics were entered into YouTube search queries. The resulting videos were screened with strict exclusion criteria. The percent accuracy of each video was calculated as compared to the SCOG checklist for the corresponding procedure.

RESULTS:

Three hundred six videos were analyzed and categorized into six groups: private practice/independent physicians (n=127), academic institutions (n=70), commercial companies (n=50), nonacademic institutions (n=32), international health care organizations (n=20), and other (n=7). Using the SCOG checklist, videos produced by international organizations had the highest percent accuracy at 50.6% followed by academic institutions at 45.8%.

CONCLUSION:

Using the SCOG checklist, there is a significant variance in the accuracy of educational videos depending on the associated publishing organization. Ob-gyn residents should be mindful of publishing organizations on YouTube videos to ensure they are learning from accurate content in line with SCOG.
How Are Cord Blood Units Being Utilized? Releases at a Private Newborn Stem Cell Bank in the United States [ID: 1377085]
Authors: Isley Lauren , James Jason
Published: May 2023

INTRODUCTION:

Cord blood preservation allows individuals future access to cord blood for stem cell transplants as well as infusions via regenerative medicine clinical trials for a wide range of indications. Although many obstetric providers are involved in the collection process, there are knowledge gaps pertaining to the actual utility of a unit, including the condition being treated and autologous (self) versus allogeneic (donor) use.

METHODS:

Data on cord blood releases at a private newborn stem cell bank from 1993 to 2021 were analyzed. Releases were separated into transplant versus regenerative medicine use. Releases were then categorized by clinical indication as well as autologous versus allogeneic use.

RESULTS:

One hundred eight releases were for transplant medicine and 568 releases were related to use in an experimental regenerative medicine application. Of the units released for stem cell transplants, 48% were used for treatment of a blood disorder, followed by 42% for malignancy. For regenerative medicine, brain injuries (51%) and developmental disorders (44%) were the most common indications for release. Most transplant medicine releases were for allogeneic use (93%), whereas the opposite was true for regenerative medicine releases, with 80% being for autologous use.

CONCLUSION:

Use of a cord blood unit is determined by the treating physician and considers many factors. There are misconceptions surrounding who in the family may be able to use a sample and under what circumstances. Encouraging education on newborn stem cell preservation options and the potential future clinical utility is key to ensure patients can make an informed decision prior to birth.
A Simple Curriculum for Teaching Transfixion Stitches Using a Low-Fidelity Model and Following Gagne's Instructional Design [ID: 1377582]
Authors: Cheng Connie , ElSahwi Karim , Vurture Gregory
Published: May 2023

INTRODUCTION:

Surgical training is often carried out through observation and practice in the clinical setting. Gagne's model of instructional design is an organized method of teaching motor skills. The purpose of the study is to evaluate the feasibility and effectiveness of using Gange's model to improve surgical knowledge on transfixation stitches used during hysterectomy on a low-fidelity pelvic model trainer.

METHODS:

A simple teaching curriculum for transfixation stitches was developed following Gange's model. A thought-provoking clinical vignette was presented and followed by clear learning objectives. Prerequisite knowledge was tested using a quiz. Stimulus material included relevant anatomy, instruments used in a hysterectomy, and steps of an abdominal hysterectomy. Learning guidance was provided in the form of diagrams and videos of various transfixation stitches. Learners practiced on low-fidelity pelvic models with supervision by faculty members. At the end, learners repeated the knowledge test and provided feedback. Comparisons were made between pretest and posttest scores using Fisher exact test and chi-square test as appropriate for nominal variables, and Mann-Whitney test for continuous variables.

RESULTS:

The simulation was performed by 18 participants (n=18). There was significant improvement in test scores after completing the simulation (59.6±21.8% versus 89.3±9.7%, P<.0001). Additionally, the number of transfixation stitches each learner was familiar with increased significantly after the simulation (0 interquartile range [IQR] [0–1] versus 4 IQR [2–4], P<.0001).

CONCLUSION:

These findings suggest that using Gagne's model of instructional design on a low-fidelity pelvic model trainer in a low-stress environment can help improve surgical skill education. Our experience demonstrates that simulation training can be organized without much time or resource and help build lasting surgical skills.
Ob-Gyn Residency Training on Caring for Incarcerated Patients: A National Survey of Programs [ID: 1379016]
Authors: Tummala Meghna , Brousseau Erin , Burrell Dayna
Published: May 2023

INTRODUCTION:

Incarcerated individuals requiring obstetric and gynecologic care make up the fastest-growing population in U.S. carceral settings. Research suggests that these patients' reproductive health needs are complex and disparate compared to the general population because of multiple forms of structural oppression. Little is known about the current state of ob-gyn resident education on providing reproductive health care to incarcerated patients.

METHODS:

A cross-sectional survey was administered by email to program leaders at U.S. obstetrics and gynecology residency programs between August and September of 2022.

RESULTS:

Program directors or assistant program directors at 101 out of 269 contactable programs (38%) completed the survey. Among respondent programs, the majority (81%) have opportunities for residents to see incarcerated patients in a clinical setting, but only a minority (23%) of programs have mandatory didactic content on providing care to these patients. When asked about the most significant barriers to offering didactic content, 71% of respondents indicated that the lack of faculty expertise on the topic is at least moderately significant, followed by other competing curricular requirements (63%). Most respondents (82%) indicated that the inclusion of such didactic content during obstetrics and gynecology residency is at least moderately valuable.

CONCLUSION:

There is a glaring gap in formal resident education on providing obstetric–gynecologic care to incarcerated patients, even though residents are actively treating these patients. Although residency program leaders believe that training residents to care for this population is important, most programs are not equipped to do so because of the existence of various barriers.
The Competitiveness of Obstetrics and Gynecology Fellowships: A 15-Year Assessment [ID: 1380331]
Authors: Schenken Claire , Michelotti Ali , Schenken Robert , Stansbury Nicholas
Published: May 2023

INTRODUCTION:

While subspecialty competitiveness for obstetrics and gynecology fellowships has evolved over the last 15 years, objective competitiveness is poorly understood. This study aimed to assess the competitiveness of obstetrics and gynecology fellowships using the normalized competitive index (NCI).

METHODS:

Obstetrics and gynecology subspecialty match data for gynecologic oncology (GO), maternal–fetal medicine (MFM), reproductive endocrinology and infertility (REI), and female pelvic medicine and reconstructive surgery (FPMRS) were obtained from the National Resident Matching Program from 2008 to 2022. The competitive index (CI) was determined by the percentage of positions filled divided by the match rate (matched applicants/total). The NCI was determined by the yearly CI divided by the average CI of the particular subspecialty. Statistical analyses included univariate analysis and linear regression.

RESULTS:

Comparing 2008–2015 versus 2016–2022, fellowship applicants (335.2±27.1 versus 381.4±19.9, P<.01) and positions (225.1±23.6 versus 294.3±22.6, P<.01) significantly increased. Match rate significantly increased for GO, MFM, and FPMRS (0.62±0.05 versus 0.68±0.02, P=.02; 0.67±0.08 versus 0.78±0.08, P=.03; 0.66±0.10 versus 0.79±0.06, P=.01, respectively), but did not change for REI (0.62±0.06 versus 0.69±0.08, P=.06). The NCI decreased for MFM (R2=0.43, P<.01) and FPMRS (R2=0.60, P<.01), from 2008 to 2022 indicating decreased competitiveness. The NCI for REI (R2=0.24, P=.06) and GO (R2=0.09, P=.27) did not significantly change.

CONCLUSION:

Match rate increased for three of four obstetrics and gynecology subspecialties, but the NCI for MFM and FPMRS decreased, indicating decreased competitiveness in these subspecialties. Therefore, the NCI may be a useful metric, in addition to the match rate, for obstetrics and gynecology subspecialty fellowship applicants to determine program competitiveness.
A Novel, Low-Fidelity, Low-Cost Residency “Simulation Festival” Competition: An Opportunity for Scholarly Innovation [ID: 1381241]
Authors: Boedeker David , Chatfield Lindsay , MacKinnon Rene , Owens Amanda
Published: May 2023

INTRODUCTION:

Simulation has rapidly expanded in obstetrics and gynecology for teaching medical knowledge, surgical skills, and maintenance of certification. Low-fidelity simulations are typically lower cost to produce and have been proven beneficial for surgical training.

METHODS:

The Junior Fellows of the American College of Obstetricians and Gynecologists District X created a competition at their Annual District Meeting in October 2022. All nine residency programs submitted and showcased a low-cost, novel simulation in obstetrics and gynecology at a 1-hour event open to all attendees. After IRB exemption was obtained, a postevent survey was completed by the participants at the event.

RESULTS:

A total of 77 individuals completed our postevent survey (medical students 12.99%, residents 58.44%, staff or fellows 28.57%). The majority of respondents felt simulation is valuable to ob-gyn training (96.10%). All respondents reported they would like to see the event repeated at future Annual District Meetings. The majority of resident responders reported they would be very likely (79.07%) or likely (18.60%) to use one of the simulations presented at the festival in future teaching or training. Fifteen respondents were involved in creating a simulation for the festival. Most simulations were very easy (60.00%) or easy (33.33%) to make, and all were reported to be very reproducible (100.00%).

CONCLUSION:

This unique event for Junior Fellows was successful in fostering innovative, low-cost, low-fidelity, highly reproducible simulations in obstetrics and gynecology. Our goals are to continue this event in future years, expand to other districts, foster reproduction of simulations at residency programs and medical schools, and support the publication of novel ideas.
The Dobbs Decision and Its Geographical Effect on Future Physician Training [ID: 1380882]
Authors: Traub Ariana , Aaron Bryan , Kawwass Jennifer , King Louise , Mermin-Bunnell Kellen , Wang Kelly
Published: May 2023

INTRODUCTION:

The United States is experiencing a physician shortage, particularly in rural and lower socioeconomic status regions. The Dobbs v Jackson Women's Health decision puts individual state health care access at the forefront of future physician's decisions on where to train and practice medicine. This study assesses how access to abortion care is changing where medical students choose to apply to residency.

METHODS:

This study surveyed third- and fourth-year U.S. medical students applying into U.S. residency programs from August 6, 2022, to October 22, 2022. Participants were selected via convenience sampling through social media and direct outreach to U.S. medical school admissions offices, medical student class presidents, and medical student organizations. 494 complete responses were analyzed.

RESULTS:

The majority (77.0%) of respondents across all medical specialties reported that access to abortion care, or lack thereof, affects the location of residency programs to which they apply. Over half (58.1%) of respondents said they are unlikely to apply to a residency program located in a state with abortion restrictions. The sample represented students applying to many specialties, with obstetrics and gynecology applicants comprising 21.6% of the sample.

CONCLUSION:

This study found that the majority of third- and fourth-year medical students' residency choices, across all specialties, are influenced by state abortion laws. Future physicians are choosing where to attend residency based on state abortion policies, indicating that access to abortion care is changing the landscape of medical practice, and has the potential to shift the geographical makeup of health care.
Perspectives on Counseling Women of Reproductive Age About Emergency Preparedness by Primary Health Care Providers: DocStyles, United States, 2021 [ID: 1364512]
Authors: Meeker Jessica , Galang Romeo , Hall Rebecca , Shapiro-Mendoza Carrie , Simeone Regina , Snead Margaret
Published: May 2023

INTRODUCTION:

Pregnant, postpartum, and lactating women (PPLW) face unique challenges during disasters that may be mitigated by emergency preparedness. Health care providers have opportunities to counsel this population on emergency preparedness, but the extent of counseling has not been reported. Our objective is to report health care provider attitudes and practices related to counseling women of reproductive age (WRA), including PPLW, on emergency preparedness.

METHODS:

DocStyles, a web-based panel survey of a convenience sample of primary health care providers in the United States, was conducted from March 17 to May 17, 2021. Family practitioners, internists, obstetrician–gynecologists, nurse practitioners, and physician assistants were asked about importance of emergency preparedness counseling, confidence level of counseling, frequency of counseling, barriers to providing counseling, and preferred resources to support counseling among their WRA and PPLW patients. We calculated frequencies of provider attitudes and practices using R, version 4.0.3.

RESULTS:

Among 1,503 respondents, family practitioners (33%), internists (34%), obstetrician–gynecologists (17%), nurse practitioners (8%), and physician assistants (8%), 88% thought that emergency preparedness for keeping reproductive-aged patients safe, and counseling patients of reproductive age about emergency preparedness were both important. However, 45% of respondents were not confident in WRA emergency preparedness counseling, and most (70%) had never talked to PPLW about this topic. Respondents cited not having time during clinical visits (48%) and lack of preparedness knowledge (34%) as barriers. Most respondents (79%) stated they would use educational materials, especially fact sheets or brochures and patient text alerts.

CONCLUSION:

Emergency preparedness resources combined with training may improve health care provider confidence in counseling WRA and PPLW.
Effect of Emotional Distress on Sleep Physiology in Underserved Pregnant Women [ID: 1381497]
Authors: Guo Yuqing , Jimah Tamara , Narvaez Laura
Published: May 2023

INTRODUCTION:

Pregnancy is characterized by an altered pattern of emotions and sleep. The aim of this study was to examine the effect of emotional distress on objective sleep parameters in underserved pregnant women during the COVID-19 pandemic.

METHODS:

Institutional review board approval was obtained for the study. This was a longitudinal observation study in which we administered weekly validated self-reported surveys (Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, COVID-19-related anxiety, and life-related stressors) to consented pregnant women over the course of their second and third trimesters (n=13). The independent variable, subjective emotional distress, was derived from a sum score of these weekly surveys. A wearable device was used to measure objective sleep physiological data, such as the rapid eye movement (REM), deep, and light sleep stages. The dependent variables were obtained from weekly average scores of the sleep data. Multilevel analysis was conducted, controlling for relevant covariates.

RESULTS:

Adjusting for gestational age, maternal age at enrollment, and prepregnancy body mass index, higher emotional distress was associated with a shorter duration of deep sleep (b=−.65, P<.05) and longer duration of REM sleep (b=.79, P<.01). There was no significant relationship between emotional distress and light sleep.

CONCLUSION:

Our study appears to be the first to provide preliminary evidence that emotional distress negatively affects sleep in terms of decreased deep sleep and increased REM sleep during pregnancy. Findings suggest that further research is needed to understand the role of sleep in the relationships between emotional distress and adverse maternal and infant health outcomes.
Elagolix Plus Add-Back Consistently Improves Uterine Fibroids-Associated Bleeding and Nonbleeding Symptoms Across Subpopulations [ID: 1368059]
Authors: Simon James , Jewell Susan , Li Moming , Ng Juki , Pinsky Brett
Published: May 2023

INTRODUCTION:

Patients with heavy menstrual bleeding (HMB) associated with uterine fibroids (UFs) have significantly improved menstrual blood loss (MBL) when taking elagolix+estradiol/norethindrone acetate add-back therapy (ELA+AB) versus placebo. However, data on the effect of ELA+AB on nonbleeding symptoms are limited.

METHODS:

This post hoc analysis from the duplicate, IRB-approved, randomized, double-blind, placebo-controlled, 6-month, phase 3 Elaris UF-1 and UF-2 studies (NCT02654054 and NCT02691494) evaluated the Patients Global Impression of Change (PGIC). Patients rated symptom change for menstrual bleeding (MB) and nonbleeding symptoms on a 7-point scale from “very much improved” (1) to “very much worse” (7).

RESULTS:

By 6 months, scores for the PGIC-MB and the domains of “abdominal or pelvic pain,” “abdominal or pelvic pressure,” “abdominal or pelvic cramping,” “back pain,” and “abdominal bloating” were significantly better (P<.001 for all; no adjustment for multiple comparisons were made) in the ELA+AB versus placebo groups, regardless of patient age (<40 years, 40 to <45 years, ≥45 years), baseline MBL (less than median [187.0 mL], greater than or equal to median), International Federation of Gynecology and Obstetrics (FIGO) classification (0–3, 4, 5–8), or baseline uterine volume (less than median [356.5 cm3], greater than or equal to median). Patients receiving ELA+AB reported PGIC domain scores that consistently exceeded “minimally improved” (≤3) and often reached or exceeded “much improved” (≤2) by 6 months.

CONCLUSION:

ELA+AB provides better bleeding and nonbleeding symptom improvement versus placebo for patients with HMB associated with UFs, regardless of subpopulation investigated. In all populations, PGIC-MB and domain scores consistently reached or exceeded “much improved” by 6 months with ELA+AB.
Novel Method for Management of Bothersome Bleeding Associated With Etonogestrel Drug Implant [ID: 1380127]
Authors: Gray Jordan , Bates G. Wright , Carlson Alexandra , Stacey Joanna
Published: May 2023

INTRODUCTION:

Nexplanon (etonogestrel drug implant [EDI]) is an effective, implantable subdermal contraceptive that releases progestin over 3 years for suppression of ovulation and thickening of cervical mucus. A significant portion of EDI patients will remove their device prematurely because of bothersome episodes of frequent/prolonged bleeding. In patients with abnormal uterine bleeding, induction of a withdrawal bleed, with the goal of reducing excessive bleeding, is a common approach. There is no standard approach to treating prolonged and/or excessive bleeding with EDI in place.

METHODS:

This is a randomized double-blinded placebo-controlled trial of 51 patients desiring EDI for contraception. Patients received norethindrone (NTA) 5 mg or placebo daily for 1 week every 4 weeks for a total of 6 months.

RESULTS:

No patients in the treatment arm requested removal because of bothersome bleeding as defined by International Federation of Gynecology and Obstetrics/World Health Organization criteria. In contrast, 24% of the placebo group participants requested removal of the device at or before 6 months from placement for a variety of reasons including bothersome bleeding. 9% from the treatment group requested early removal; however, none for bothersome bleeding. 80% of the treatment group participants had a satisfactory bleeding pattern. One participant in the treatment arm complained of unsatisfactory amenorrhea.

CONCLUSION:

We propose a novel method to manage bothersome bleeding associated with EDI. Our data suggest that cyclic NTA is an effective method to treat bothersome bleeding in patients using etonogestrel implants for contraception and warrants further study.
Self-Assessment and Modulation of Applied Force During Shoulder Dystocia Simulation Training [ID: 1376207]
Authors: Islam Rushnan , Allen Robert , Allen Edith Gurewitsch , Sant'Anna Marinho Caio
Published: May 2023

INTRODUCTION:

Diagnosis of shoulder dystocia (SD) relies on clinicians' subjective assessment of the need to apply “more-than-usual” traction. We sought to determine whether providers' diagnostic traction (DT) for SD in a simulated setting is modifiable by force training.

METHODS:

As part of an IRB-approved study, we tethered a fetal mannequin with embedded force sensors to a simulated pelvis such that it would not deliver. We asked participants to apply their DT for SD, and then stop. We then asked them to apply their own estimate of 20 lb of traction, which is below the published 22-lb threshold for brachial plexus injury. Blinded from participants' view, we recorded the actual force applied at each attempt and asked each participant to estimate in pounds the DT they perceived to have applied. We then revealed actual force applied and allowed participants to practice with actual force measurements in view; this was followed by another blinded sequence of traction applications and estimations. Differences between actual and estimated DT pretraining and posttraining, were compared using t test, with significance at P less than .05.

RESULTS:

The mean DT among 103 participants decreased from 15.3 to 12.3 lb posttraining (P<.0001). Pretraining, participants underestimated their own applied traction by an average of 30% (9.3±5.2 versus 15.3±7.9 lb, P<.001); accuracy of self-assessment improved to 100% post-training (12.1±5.5 versus 12.3±5.0 lb, P=.66).

CONCLUSION:

With force training, accuracy of self-assessment of DT improves significantly; and applied force to diagnose SD decreases significantly below injury threshold.
Effects of Abstinence From Opioid on Neuropsychological Performance in Men With Opioid Use Disorder: A Longitudinal Study
Authors: Kaur Gurneet , Sidana Ajeet , Singh Swarndeep , Gupta Aarzoo
Published: May 2023

Objectives

Impairments in neuropsychological functioning (mainly memory, learning, attention, and executive functioning) among persons with long-term opioid use disorder (OUD) have been widely reported, with few studies suggesting that these are not permanent and can improve with abstinence. Thus, present study aimed to evaluate the neuropsychological functioning in persons with OUD and examine the effects of abstinence on the same over a period 8 weeks.

Methods

A total of 50 patients with diagnosis of OUD as per the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria underwent serial longitudinal neuropsychological assessments for executive functioning, attention and concentration, and verbal and nonverbal memory at baseline, 2 weeks, and 8 weeks of abstinence.

Results

The mean performance scores representative of attention, concentration, verbal memory, and nonverbal memory showed significant improvement in the initial 2 weeks, and executive functioning showed significant improvement by 8 weeks of abstinence (all P’s < 0.01). A significant negative correlation was found between the duration of opioid use and performance on verbal memory tests (0.014), the frequency of intake per day and performance on nonverbal memory and executive functioning tests, and the severity of opioid dependence and performance on nonverbal memory test (0.019).

Conclusions

Neuropsychological functioning in certain domains was associated with the duration of opioid use, the frequency of daily opioid intake, and the severity of opioid dependence among persons with OUD at baseline. It showed significant improvement in domains of attention, concentration, verbal and nonverbal memory, and executive functions over a period of 8 weeks of abstinence.
Correlates and Patterns in Use of Medications to Treat Opioid Use Disorder in Jail
Authors: Bailey Amelia , Senthilkumar Rithika , Evans Elizabeth A.
Published: May 2023

Objectives

Little is known about the correlates of use of medications to treat opioid use disorder (MOUD, ie, buprenorphine, methadone, naltrexone) offered in jails. We evaluated the implementation and outcomes of a MOUD program offered by 2 of the first jails nationwide to provide access to such care.

Methods

We examined use of MOUD among adults with opioid use disorder (n = 347) incarcerated by 2 rural jails in Massachusetts (2018–2021). We examined MOUD transitions from intake to during incarceration. Using logistic regression, we examined factors associated with in-jail use of MOUD.

Results

At jail entry, 48.7% of individuals with opioid use disorder were being treated with MOUD. During incarceration, 65.1% received MOUD, attributable to a 9.2% increase in use of methadone (from 15.9% to 25.1%) and a 10.1% increase in use of buprenorphine (from 28.5% to 38.6%). During incarceration, 32.3% of individuals were continued on the same MOUD from the community, 25.4% were started, 8.9% stopped, and 7.5% switched type. A total of 25.9% entered jail not on any MOUD and were not started on it. Use of MOUD during incarceration was positively associated with having received MOUD in the community (odds ratio, 12.2; 95% confidence interval, 5.8–25.5) and incarceration at site 1 compared with site 2 (OR, 24.6; 95% CI, 10.9–54.4).

Conclusions

Expanded access to MOUD in jails can engage an at-risk population with treatment. Understanding factors related to this population’s use of MOUD may aid efforts to optimize care during incarceration and after community re-entry.
Cesarean Delivery Rate in Nulliparous Women in the Second Stage of Labor When Using Zhang Compared With Friedman Labor Curves
Authors: Limas Maria M. , Shah Sohum C. , Turrentine Mark A.
Published: May 2023

OBJECTIVE:

To estimate the cesarean delivery rate in the second stage of labor in nulliparous women when using the Zhang compared with the Friedman labor curve by performing a systematic review and meta-analysis.

DATA SOURCES:

We explored MEDLINE, EMBASE, Web of Science, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials for studies comparing the cesarean delivery rate in the second stage of labor in nulliparous women when using the Zhang compared with the Friedman labor curve.

METHODS OF STUDY SELECTION:

Two reviewers separately ascertained studies, obtained data, and gauged study quality. The cesarean delivery rate was compared, and odds ratios (ORs) with 95% CIs were estimated.

TABULATION, INTEGRATION, AND RESULTS:

Five retrospective cohort studies and two randomized controlled trials were identified with 20,165 nulliparous women (10,861 with the Zhang labor curve vs 9,304 with the Freidman labor curve). Studies evaluated women with delivery from June 2010 to May 2017. Two studies were from the United States; two were from Israel; and one each was from China, France, and Norway. The median point prevalence of cesarean delivery in the second stage was 4.0% (95% CI 2.1–14.5%) in cases managed with the Zhang labor curve compared with 5.6% (95% CI 1.8–28.6%) in cases managed with the Friedman labor curves. The overall cesarean delivery rate in the second stage of labor was similar when the Zhang labor curve compared with the Friedman labor curve was used (pooled OR 0.86, 95% CI 0.47–1.57, I
2=93%). When the two randomized controlled trials were excluded, the results of the cohort studies continued to demonstrate that the overall cesarean delivery rate in the second stage of labor was similar (pooled OR 0.84, 95% CI 0.42–1.69, I
2=92%).

CONCLUSION:

Nulliparous women have similar cesarean delivery rates in the second stage of labor when either the Zhang or Friedman labor curve is used.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42022346425.
The Influence of Fetal Sex on Antepartum Treatments in a Murine Model of Preterm Birth [ID: 2369702]
Authors: Ligon Sarah E. , Dornisch Elisabeth M. , Howitz Kamy J. , Talley Rebecca L. , Damicis Jennifer R. , Napolitano Peter G. , Pates Jason A. , Ieronimakis Nicholas
Published: May 2023

INTRODUCTION:

Preterm neonates exposed to magnesium sulfate (MgSO4) and corticosteroids such as betamethasone (BMTZ) in utero have a lower incidence of neurodevelopmental disability, specifically cerebral palsy. The efficacy of MgSO4/BMTZ remains poor, particularly in male offspring. The mechanisms by which MgSO4/BMTZ confer “neuroprotection” in only some patients and in relation to fetal sex, remain unknown. Our objective was to examine sex-specific responses to MgSO4/BMTZ in a murine model of fetal neuroinflammatory injury.

METHODS:

Utilizing an established murine model of preterm birth, dams were injected intrauterine with either phosphate-buffered saline or bacterial endotoxin (lipopolysaccharide [LPS]) on embryonic day 15.5 to induce fetal inflammation. Thereafter, dams received MgSO4/BMTZ or the vehicle. Fetal brains and placentas were collected 6 hours postinjection for gene expression analysis of key inflammatory cytokines: Il1b, Il6, and Tnf.

RESULTS:

Irrespective of sex, LPS exposure up-regulated all three cytokines. With MgSO4/BMTZ, Il1b expression was significantly lower in female, but not male brains. In contrast, MgSO4/BMTZ lowered Il6 expression in placentas from males, but not females. No sex differences were observed with Tnf expression.

CONCLUSION:

Within the context of LPS-mediated in utero inflammation, fetal sex influenced the efficacy of MgSO4/BMTZ. The anti-inflammatory effect of MgSO4/BMTZ also appeared tissue specific, with protection shown in female brains and male placentas. These results suggest that the neuroprotective effects of MgSO4/BMTZ are more robust in females, whereas placental inflammation is more affected in males. Further investigation is warranted to determine whether these sex-specific patterns govern fetal outcomes.