bluuebunny/crossref_metadata_2025 huggingface dataset:
Inflammatory Bowel Disease and Biologic Use During Pregnancy and Its Association With Postpartum Disease Activity [20M]
Authors: Rekawek Patricia , Bigelow Catherine , Getrajdman Chloe , Roy-McMahon Christine , Johnson Shaelyn , Mella Maria T.
Published: April 2020

INTRODUCTION:

Women with inflammatory bowel disease (IBD) have an increased risk of developing a postpartum flare. There is limited data regarding the effects of antepartum biologic use on disease activity postpartum. Our objective was to identify risk factors associated with postpartum flares and evaluate the effect of antepartum biologic use on the rate of postpartum flares.

METHODS:

This was a retrospective study of pregnant patients with IBD who delivered at a single tertiary care institution from 2012 to 2017. Maternal demographics between patients who experienced an IBD flare postpartum versus those who did not were compared using Wilcoxon tests for continuous measures and Fisher’s exact tests for categorical measures. The incidence of postpartum flares was compared between groups defined by exposure and non-exposure to biologics using a Fisher’s exact test.

RESULTS:

Of the 260 patients included in the analysis, 13 (5%) experienced an IBD flare postpartum. Patients who experienced an IBD flare postpartum were more likely to experience a flare during pregnancy (8/13 [61.5%] versus 29/247 [11.7%], P<.001). There was a significantly increased risk of IBD flare postpartum associated with biologic use in pregnancy (8/70 [11.4%] versus 5/190 [2.6%], p=0.008).

CONCLUSION:

Increased severity of IBD measured by flares during pregnancy is associated with an increased rate of postpartum flare. The association of biologic use with a postpartum flare is likely due to increased disease severity. Future studies are needed to further evaluate timing of biologic use in utero and its association with postpartum disease activity in patients with IBD.
Safety of Prophylactic Measures to Decrease Surgical Complications for Pregnancy Complicated by Placenta Accreta [35M]
Authors: Lazaro Jose J. , Rochon Meredith , Quinones Joanne , Giagni Chelsea , Smulian John , Scorza William
Published: April 2020

INTRODUCTION:

The objective of this study is to determine the safety and efficacy of routine prophylactic measures to prevent surgical complications during peripartum hysterectomy for placenta accreta spectrum, including placement of pelvic vascular occlusion catheters (PVOC) for uterine artery occlusion or embolization (UAE) and ureteral stents (US).

METHODS:

This is a retrospective cohort study of women undergoing peripartum hysterectomy for pathologically confirmed placenta accreta spectrum from December 1, 2007 to June 30, 2019. Medical records were reviewed for intraoperative details and surgical outcomes, including use of, and complications related to PVOC, UAE and US. Women who had any prophylactic procedure were compared with those that had none. Primary outcome was complications related to use of each prophylactic measure. Data were analyzed using univariate and multivariable techniques.

RESULTS:

A total of 71 women underwent peripartum hysterectomy. 45 women had at least one prophylactic measure: 40 had PVOC or UAE and US, and 5 had US only. Use of any prophylactic measure was associated with an increase in total operative time (P<.0001) and a decrease in blood loss (P<.0001), need for transfusion (P<.001) and maternal ICU admission (P<.001). There were no complications related to US placement, and one complication related to PVOC. There were no differences in rates of ureteral injury, bladder injury or bowel injury between women that had prophylactic measures and those that did not.

CONCLUSION:

Routine use of prophylactic measures at cesarean hysterectomy, including PVOC and US appear to be safe and associated with decreased blood loss and maternal ICU admission.
Trauma Informed Care Training in Ob/Gyn Residency Programs [26G]
Authors: DeAndrade Samantha , Pelletier Andrea , Bartz Deborah , Dutton Caryn
Published: April 2020

INTRODUCTION:

One in six American women experience sexual abuse in their lifetime, which pre-disposes a large percentage of our patients to post-traumatic stress disorder. Patients report being re-traumatized when undergoing exams during childbirth and routine Ob/Gyn visits. Very little is known about whether Ob/Gyn physicians are trained to care for patients who have experienced trauma.

METHODS:

This study was a cross-sectional survey administered to program directors at all US and Canadian Ob/Gyn Residency programs in September of 2019.

RESULTS:

At this time, 58 out of 241 (24%) program directors have responded to the survey and represent all ACOG districts. Over 20% of programs have formal training that occurs every year, 63.8% have had some training occur in the past though not on a regular basis, and 15.5% have never had any training. When asked about the primary barrier to providing this training, 27.6% of respondents cited the lack of facilitators to teach it, followed by lack of time within the residency curriculum (17.2%). About 30% of respondents are satisfied with the current training provided at their program. All respondents agree that Ob/Gyn residents need to be trained in trauma informed care, 60.3% believe it should be a CREOG educational objective, and 88% would be somewhat or extremely likely to implement a training program specifically designed for Ob/Gyn residents if one became available.

CONCLUSION:

Most Ob/Gyn residency programs are providing some training on the care of patients who have experienced trauma, however respondents in our sample are largely unsatisfied with how this occurs.
The Impacts of Obstetrical Simulation Training for Emergency Medical Service Providers [40G]
Authors: Peterkin Veronica C. , Robinson Jaimee , Marko Emily K.
Published: April 2020

INTRODUCTION:

Obstetrical emergencies in the field require coordinated time-sensitive teamwork between emergency medical services (EMS) and hospital-based teams. Simulation is effective at preparation for emergencies. The study objective was to determine the educational and clinical impacts of simulation training sessions for emergency medical service personnel by obstetrical teams within the same communities.

METHODS:

A multi-center prospective pre/post educational study design was used to assess the effectiveness of a curriculum designed for emergency medical service providers on obstetrical emergencies. Instructional strategies included team-based checklist review and skills coaching using low-fidelity task trainers, taught by interdisciplinary teams. Outcomes were measured using pre/post educational tests, team performance assessments, course evaluations and clinical impacts. Internal review board exemption was obtained. Paired t-tests were used for data analysis.

RESULTS:

Over 18 months, 185 EMS personnel participated in the curriculum taught at 2 community hospitals. Instructors included obstetricians, emergency physicians, nurses, and medical students. Significant improvement in knowledge was achieved (pre 47.8%, post 89.6%, P<.0001). Confidence (1=high, 5=low) improved in managing precipitous delivery (pre 3.77, post 1.52, P<.0001), shoulder dystocia (pre 4.0, post 1.48, P<.0001), eclampsia (pre 2.68, post 1.29, P<.0001), breech (pre 4.68, post 2.21, P<.0001), and PPH (pre 3.68, post 1.33, P<.0001). Team performance assessments demonstrated significant improvement (pre 68.54%, post 93.54%, P<.0001). Qualitative clinical impacts included improvements to EMS protocols, transfer of care and communication between teams.

CONCLUSION:

Simulation training in obstetrical emergencies for emergency medical service providers improves knowledge, skills, and performance. Instruction by obstetrical teams in the same communities enhances communication and collaborative care.
Case Report: Retroperitoneal Abscess After Uncomplicated Spontaneous Vaginal Delivery [19H]
Authors: Score Samantha A. , Gallagher Kristen , Wahl Geneva , Archil Vanessa
Published: April 2020

INTRODUCTION:

Retroperitoneal abscess following an uncomplicated vaginal delivery is uncommon and may be potentially life-threatening. We present a case of a multiparous 36 year old patient who developed a large retroperitoneal abscess following an uncomplicated vaginal delivery, requiring CT-guided fluid drainage and intravenous antibiotics.

METHODS:

Patient consent was obtained for this case report. Our patient is a 36 year old multiparous female who presented in spontaneous labor. She was febrile to 101.0 and started on empiric antibiotics. She underwent an uncomplicated spontaneous vaginal delivery with intact perineum without anesthesia. She remained afebrile and antibiotics were discontinued. Patient again developed fever to 102.5 prompting consult to infectious disease. Recommendation was made for broad spectrum antibiotics. She presented 3 weeks later with complaint of constipation, abdominal swelling, and pain. A palpable mass was noted, and patient was sent to the emergency department. CT scan showed heterogeneous fluid collection in the retroperitoneal left lower quadrant measuring 14.1 x 6.5 x 13.4 cm. Interventional radiology was consulted and she was taken for CT-guided drainage of fluid collection. Fluid culture resulted as Streptococcus pyogenes. IV antibiotics were adjusted based on culture and continued for 14 days. Follow up imaging demonstrated near-complete resolution of fluid collection.

CONCLUSION:

Diagnosis of a retroperitoneal abscess requires a high level of suspicion. In this case, we highlight the importance of postnatal follow-up and a low threshold for postpartum imaging. A multidisciplinary approach to treatment is important. Initiation of broad-spectrum antibiotics and drainage of the abscess should be arranged if diagnosis is made.
A Preliminary Analysis of a Multidisciplinary Fibroid Clinic Patient Satisfaction and Demographics [10F]
Authors: Josephson Rebecca J. , Hatfield Joanna , Forbes Marci Messerle
Published: April 2020

INTRODUCTION:

Fibroids are benign growths of the uterine muscle that can cause a variety of symptoms including abnormal uterine bleeding, pelvic pain, and bulk symptoms. Our institution created a dedicated multidisciplinary Fibroid Program to address the needs of patients with symptomatic fibroids. Cases were reviewed with gynecologists, diagnostic radiologists, and interventional radiologists to provide tailored treatment plans and counseling for patients.

METHODS:

Patients seen between 1/2014 and 8/2018 (n=312) completed intake surveys detailing demographic background, prior treatments, most problematic symptoms, and a validated quality of life (UFS-QOL) survey. One-year follow up surveys about treatments, Likert scale rated satisfaction, and updated UFS-QOL were sent out to all patients and responses (n=111) were analyzed. Chart review clarifying fibroid size and locations was also performed.

RESULTS:

The average age of patients was 43.6 ± 0.4 years old. Upon initial presentation, 70.1% reported abnormal bleeding, 80.6% had pain, 44.3% had urinary symptoms, 77.4% had abdominal fullness, and 32.5% had bowel complaints. The average UFS-QOL score prior to treatment was 53.0 (out of 100). After treatment the average UFS-QOL score was 78.3, a difference of 25.3 points after being seen in the Fibroid Program. Patient reported satisfaction was excellent, with 79.2% of patients rating their satisfaction at 5 out of 5.

CONCLUSION:

Patients had a high rate of satisfaction after participation in our multidisciplinary Fibroid Program and UFS-QOL scores improved. We hope that this model can continue to be used to improve the life of patients by demonstrating the success of multidisciplinary informed counseling, tailored treatment, and shared-decision making.
A Comparison Between Obstetrician-Gynecologists Practicing in Rural and Metropolitan Counties in New Mexico [09F]
Authors: Rayburn William , Yoder Katelyn , Quiner Trevor , Blackstone Jacquelyn
Published: April 2020

INTRODUCTION:

About one-half of all U.S. counties lack obstetrician-gynecologist physicians (ob-gyns) especially in rural areas. The objective of this study was to use experience in our state identify demographic and practice characteristics distinguishing ob-gyns in general practice (general ob-gyns) in rural and metropolitan settings.

METHODS:

This retrospective observational study used self-reported responses by physicians to a mandated survey about demographics and practice patterns at the time of New Mexico medical relicensing. Included in the study were all general ob-gyns in 2016 and 2017. Information about subspecialist ob-gyns and residents who graduated that year was obtained from the American College of Obstetricians and Gynecologists and the Accreditation Council for Graduate Medical Education from 2016 to 2019.

RESULTS:

Nearly 1 in 3 (84 of 273, 30.8%) general ob-gyns practiced in a rural county. Those in rural settings tended to be older (P=.02) and male (P=.04). Most had practices in both obstetrics and gynecology. Compared with those in metropolitan counties, general ob-gyns in rural counties practiced in smaller groups (P=.0003) and worked 40 or more hours weekly (P=.0003). All subspecialists practiced in the most populous metropolitan county. No recent residency graduate practiced rurally in New Mexico.

CONCLUSION:

General ob-gyns in New Mexico’s rural counties practiced in smaller groups and worked longer work hours. Rural ob-gyns tended to be older and male. More training opportunities in rural communities with maternity centers may aid in recruiting resident graduates.
Increasing Equity in Tdap Vaccination in Pregnancy: Using Data to Drive a Quality Improvement Project [15F]
Authors: Lalla Amber , Leyba Katarina , Stonehocker Jody , Martinez Melissa
Published: April 2020

INTRODUCTION:

National guidelines recommend the Tdap vaccine during 27-36 weeks gestation to confer immunity to the neonate. At the University of New Mexico, Title V-funded clinics that provide prenatal care for uninsured women do not provide on-site Tdap, but refer women to the Department of Health (DOH) for vaccination. Other university clinics stock the vaccine on-site. We sought to compare rates at Title V clinics to university-based obstetrical and family medicine clinics.

METHODS:

A retrospective review of electronic health records was performed for women who received prenatal care at Title V, obstetric, and family medicine clinics in 2018. Patients were crossed checked in the New Mexico Statewide Immunization Information System to include DOH records. Statistical significance was assessed using two-sample tests of proportion and a logistic regression.

RESULTS:

Results from 372 charts revealed the rate for Title V clinics (31.94%) was significantly lower than the rates for obstetrical clinics (71.91%, P<.02) and family medicine clinics (90%, P<.001). Controlling for demographic factors, women at Title V clinics were 80% less likely to get a Tdap vaccine than women who went to obstetric clinics (P<.001).

CONCLUSION:

Title V clinic patients are less likely to receive Tdap than patients who receive care at clinics with Tdap on-site. Providing on-site Tdap vaccination for uninsured pregnant women is a matter of health equity. Advocating for change by addressing specific barriers is ongoing. The results of this study have guided a comprehensive quality improvement project, resulted in the donation of on-site vaccines, and inspired a larger DOH study.
Pneumococcal Vaccines in Pregnancy: Understanding Indications and Knowledge Gaps [22F]
Authors: DeGrio Angela , Erickson Laurie P.
Published: April 2020

INTRODUCTION:

The Center for Disease Control and Advisory Committee on Immunization Practices recommends the pneumococcal vaccine for patients with specific medical comorbidities. Many obstetric patients qualify for the vaccination and the prenatal period provides an ideal opportunity for intervention. The primary objective of this study was to determine how many patients are potential candidates to receive the vaccine series, and secondarily, to assess resident knowledge.

METHODS:

A retrospective chart review was performed of women receiving prenatal care at an academic ambulatory clinic between 12/2016-12/2017 to determine the number of patients who met criteria for the pneumococcal vaccine. A survey was administered to residents to evaluate the level of confidence surrounding immunization recommendations and prescribing patterns.

RESULTS:

Of the 302 patients who presented for OB care during the study period, 24% met criteria for the pneumococcal vaccine (75/302). The top three qualifying criteria were smoking (33), asthma (20), and diabetes (11). Two patients were diagnosed with upper respiratory tract infections that required antibiotics, and there were no cases of pneumonia. The immunization rate for influenza and Tdap vaccines were 55% and 69% respectively. Residents in the survey expressed a comfort level of 6.5/10 with understanding prenatal vaccine recommendations, 3.8/10 for comfort level of understanding candidates for the pneumococcal vaccines.

CONCLUSION:

A significant number of obstetric patients are candidates for the pneumococcal vaccine. Residents self-identify a gap in knowledge surrounding recommendations for this vaccine series.
Battling Maternal Mortality Through Access to Primary Care Physicians [26F]
Authors: Yadav Ghanshyam S. , Angraal Suveen , Turrentine Mark , Nagarkatti Nupur
Published: April 2020

INTRODUCTION:

Chronic disease among reproductive aged women has been implicated as one of the reasons for the high maternal mortality rate in the United States. Primary care physicians (PCPs) play a vital role in maintaining life-long health and in management of chronic diseases. We evaluated the association between prevalence of PCPs and maternal mortality rates.

METHODS:

County-level data on number of PCP’s and maternal mortality rates in 2014 was obtained from the American Medical Association and National Vital Statistics System, respectively. County level population metrics from the Census Bureau were used to estimate the number of PCPs per 100,000 population. Linear regression model was used to assess association of PCP rate with county-level age-standardized maternal mortality rates. Furthermore, we compared counties with no PCPs, with an equivalent number of counties with highest rate of PCPs. Relative risk reduction for maternal mortality was calculated.

RESULTS:

Data were available for 3069 (97.6%) counties. National maternal mortality rate (per 100,000 population) in 2014 was 0.35 (95% CI 0.33–0.37). At the county level, number of PCPs per 100,000 was negatively associated with maternal mortality rate after adjusting for various socio-demographic factors (P<.001). 149 counties in the United States had no PCPs. When compared with 149 counties with highest number of PCPs per 100,000 population, the maternal mortality rate was significantly higher (0.36 versus 0.28, respectively P<.01).

CONCLUSION:

Higher maternal mortality rates are noted in counties with a lower prevalence of PCP’s. Improving access to PCPs may reduce maternal mortality rates in the United States.
Standardization of Care Following a Positive Behavioral Health Screen in Pregnancy [32F]
Authors: Dean Sara M. , Jackson Aimee , Denning Stacie , Gandhi Manisha
Published: April 2020

INTRODUCTION:

Provider bias plagues behavioral health screening in pregnancy. One in three pregnant women will utilize illicit substances, experience depression/anxiety, or be a victim of violence. Following our Phase I results presented in 2019, we aimed to develop a standardized algorithm for providers to guide response to positive behavioral health screens.

METHODS:

Through an IRB approved protocol, we screened 260 patients at three intervals during pregnancy between January and June 2019. Patients in a Maternal Fetal Medicine clinic voluntarily completed the Integrated Screening Tool at three separate encounters. A novel, evidence-based algorithm was developed and utilized to guide provider response to a positive screen.

RESULTS:

During the study period, 479 eligible screening visits occurred among 260 patients. Compared to Phase I, indicated urine drug screen (UDS) completion increased from 13% to 80% (P<.001), of which 11% were positive. Across the screening intervals, 65% of patients with an initial positive screen, subsequently answered negative. Of the patients who initially screened negative, 25% had a positive screen later in pregnancy, of which 33% UDS were positive. Referral to mental health services for patients with a positive emotional health screen increased by 100% following implementation of the algorithm (P<.002).

CONCLUSION:

Utilizing a standardized algorithm guiding provider response to behavioral health screening in pregnancy significantly increased provider action yet did not identify a significant increase in detecting patients using illicit substances. Longitudinal screening is important as patients are likely to change their response. Additional study is indicated to further establish validity of this novel algorithm.
The Patient Perspective on the HPV Vaccine and Its Recently Expanded Coverage [33F]
Authors: Caja Madison , Hashmi Mahreen
Published: April 2020

INTRODUCTION:

The objective of this study is to explore the patient understanding of HPV and its vaccine and to ascertain any pertinent biases. The human papilloma virus (HPV) vaccine was recently FDA approved to extend coverage to age 45 instead of age 26. The vaccine is recommended by ACOG for males and females aged 9-45.

METHODS:

Between April and June 2019, patients of WVU Medicine OBGYN completed a one-time survey at their well-woman examination. The survey was created to assess associations between socioeconomic variables, sexual history, and the patient perception of the HPV virus and vaccine.

RESULTS:

A total of 200 women participated. The average age was 45 with most currently sexually active (84%). While most women reported that they were in support of vaccines (95%), the majority of women without a previous HPV vaccination reported they were not interested in receiving the vaccine themselves (48%) but were more likely to be in favor to vaccinate their sons (57%). It should be noted 0 women reported all of the correct cancers associated with HPV with only 7 women reporting the association with head and neck cancers. Almost a quarter of women (21%) incorrectly believed HPV had links to uterine and ovarian cancer.

CONCLUSION:

There are visible gaps regarding HPV and its vaccine. A major gap is the paucity of knowledge of the types of cancers HPV can cause. Physicians can recognize potential candidates and implement more education within the well-woman visit to make sure women are well-informed about HPV and the vaccine.
Healthcare Providers as Fertility Information Sources for Cis Heterosexual Women and LGBTQ+ Individuals [15G]
Authors: Worthington Amber , Shirazi Talia , Abrams Mere , Burke Erin , Leahy Carly
Published: April 2020

INTRODUCTION:

Healthcare providers are important sources of fertility information; however, all individuals may not have access to or feel comfortable communicating with providers about fertility. We evaluated current and preferred sources of fertility information, as well as efficacy to communicate with providers about fertility in cis heterosexual women and LGBTQ+ individuals.

METHODS:

Participants (N=514) included cis heterosexual women (n=311) and LGBTQ+ individuals (n=203). The data were gathered using a 2019 IRB-approved online survey and analyzed using descriptive statistics and independent sample t-tests.

RESULTS:

Cis heterosexual women’s top current fertility information sources included general providers (59.8%) and health-focused websites (46.9%); cis heterosexual women would prefer general providers (73.3%) and specialists (57.6%). LGBTQ+ individuals’ top current fertility information sources included health-focused websites (43.8%) and social media (33.5%); LGBTQ+ individuals would prefer general providers (70.4%) and specialists (51.2%). Cis heterosexual women (M=3.94, SD 0.79) had higher efficacy to communicate with providers about fertility than LGBTQ+ individuals (M=3.19, SD 1.12; t(331.57)=8.28***). (***P<.001).

CONCLUSION:

We found that providers are preferred sources of fertility information for cis heterosexual women and LGBTQ+ individuals, and LGBTQ+ individuals are less comfortable communicating with providers about fertility. To facilitate all individuals’ abilities to achieve their reproductive and family planning goals, providers should be aware that they are preferred sources of fertility information for cis heterosexual women and LGBTQ+ individuals and should create an inclusive environment for LGBTQ+ communication about fertility.
Alkaline Phosphatase Levels in Pregnancy and Its Association With Birth Weight: Prospective Cohort [03O]
Authors: Lambers Donna , Schadler Brittny , Devaiah Ganga , Thomas Megan
Published: April 2020

INTRODUCTION:

Alkaline phosphatase (ALP) is produced by placental syncytiotrophoblasts and levels are normally increased in pregnancy. The aim was to determine if total ALP level between 24–28 weeks could be used as a screening tool in healthy singleton pregnancies as a predictor for low birth weight.

METHODS:

An IRB approved prospective study with total ALP serum levels collected from women with a singleton pregnancy between 24–28 weeks gestation. Pregnancies complicated by conditions that could affect ALP levels or fetal growth were ineligible. Pregnancy and birth data was abstracted from the patient's chart. Infants were classified as SGA, AGA and LGA by gestational age at birth and gender.

RESULTS:

255 patients had complete ALP level and delivery outcome data. There were no statistically significant differences in baseline maternal demographic characteristics noted between groups. Mean gestational age at delivery was 39.1 weeks. ALP levels in the SGA group, 83 (±35) IU/L, were not significantly higher when compared to the AGA group, 69 (±21) (P=.062), and LGA group was 78 (± 21) IU/L. Mean birth weights for SGA, AGA and LGA were 2609 (±282), 3247 (±486), and 4118 (±290) gm. Mothers of SGA infants had lower GCT results at 94.9 (±23.4) mg/dL as compared to mothers of AGA infants 107.6 (±25.5), P=.016. Patients who developed gestational hypertension were more likely to have ALP levels >75th% (P=.002).

CONCLUSION:

There was only a weak association noted between ALP levels at 24 to 28 weeks gestation in healthy singleton pregnancies and birthweight. Therefore, ALP performs poorly as a way to screen for SGA growth in newborns.
Fetal Bradycardia in Response to Maternal Hypothermia [15O]
Authors: Spires Benjamin , Towers Craig V.
Published: April 2020

INTRODUCTION:

Fetal bradycardia, especially if it develops abruptly in the setting of a normal fetal heart (FHR) tracing, is most often associated with fetal compromise. The differential diagnosis may include numerous maternal, placental, and fetal conditions that would prompt emergent delivery. These causes are usually associated with an absence of FHR accelerations and decreased or absent variability. On the other end of the spectrum, fetal tachycardia also has numerous causes, one of which is maternal fever (or hyperthermia). Therefore, it is plausible that the opposite effect of a low maternal temperature or hypothermia might produce fetal bradycardia. The purpose of this case series is to demonstrate this finding.

METHODS:

6 cases of fetal bradycardia associated with maternal hypothermia were collected. Data collection included gestational age at presentation, maternal medical condition, maternal temperature, FHR baseline, presence and/or absence of FHR variability and accelerations, and pregnancy outcome.

RESULTS:

All 6 cases demonstrated FHR baselines in the 80–90s in the setting of maternal hypothermia. Maternal temperatures ranged from 92.1–96.9 0F. All had moderate variability with the presence of accelerations. All FHR baselines returned to normal with correction of maternal temperature. No adverse outcomes were seen in the 6 neonates post-delivery.

CONCLUSION:

These cases demonstrated fetal bradycardia can be seen in the presence of maternal hypothermia. The appearance of the FHR tracing is reassuring, except for the baseline. Therefore, emergent delivery is not indicated. The FHR baseline returns to normal with correction of maternal temperature. The overall clinical picture should be taken into consideration before proceeding with delivery.
Thirty Million Strong
Authors: Mancuso Leslie , Davidson Patricia M.
Published: April 2020

What our profession needs to look like in the upcoming decade.
FDA Requests Withdrawal of Weight-Loss Drug From Market
Authors: Aschenbrenner Diane S.
Published: April 2020

The Food and Drug Administration has requested that the manufacturer of lorcaserin (Belviq, Belviq XR), a serotonin 2C receptor agonist used as an adjunct to diet and exercise for weight loss, voluntarily withdraw the drug from the U.S. market because of an increased occurrence of cancer.
Embracing a Role from Nursing's Past
Authors: Fauteux Nicole
Published: April 2020

This is the first of three articles exploring ways in which frontline nurses may be affected by recommendations of the forthcoming National Academy of Medicine Future of Nursing 2020-2030 study.
Any Number of HPV Vaccine Doses Reduces Risk of Cervical Cancer
Authors: Rosenberg Karen
Published: April 2020

According to this study:

Among girls and women 15 to 19 years of age, receipt of one, two, or three doses of the human papillomavirus vaccine is associated with a reduced incidence of preinvasive cervical lesions compared with no vaccination.
Aspirin For VTE Prevention After Joint Replacement
Authors: Rosenberg Karen
Published: April 2020

According to this study:

In terms of clinical effectiveness and safety, aspirin isn't significantly different from the other anticoagulants used to prevent venous thromboembolism after total hip or knee replacement.

Patients receiving aspirin had a lower risk of bruising and lower limb edema.
The personal and professional responsibilities of NPs in disaster response
Authors: Zak Concetta L. , Wood Laura Kay , Adelman Deborah S. , Fant Catherine
Published: April 2020

The fourth article in the Disaster Series presents the various duties that NPs may assume in a disaster. NPs possess advanced clinical knowledge and skills that position them to play key roles in all phases of a disaster.
Treating postpartum depression with brexanolone
Authors: Burval Jessica , Kerns Rachel , Reed Kim
Published: April 2020

The FDA has approved brexanolone specifically for treatment of adults with postpartum depression (PPD). Administered I.V., it can relieve severe signs and symptoms of PPD within days rather than weeks. This article discusses the benefits and risks of brexanolone as a treatment for PPD, including nursing considerations and patient teaching.
Anatomical Variability Predisposed a Child to Permanent Brachial Plexopathy following Incidental Trauma
Authors: Sharif-Askary Banafsheh , Mantilla-Rivas Esperanza , Mamidi Ishwarya , Talbet Joseph , Manrique Monica , Aivaz Marudeen , Keating Robert F. , Oh Albert K. , Rogers Gary F.
Published: April 2020

Anatomic variations in peripheral nerves and the perineural environment are common and can contribute to acute or chronic neuropathy in certain individuals. Awareness of these variants is relevant to understanding both the etiopathogenesis and the increased susceptibility to nerve injury in some patients. We present a 4-year-old boy who sustained a permanent injury to the upper brachial plexus from a relatively minor trauma. Surgical exploration revealed a variation in upper trunk anatomy that likely contributed to this outcome.
Anesthetic considerations for functional endoscopic sinus surgery: a narrative review
Authors: Saxena Amit , Nekhendzy Vladimir
Published: April 2020

This review article discusses state-of-the-art perioperative anesthesia care for patients presenting for functional endoscopic sinus surgery (FESS). A comprehensive literature review (years 2000–2019) was performed with a focus on FESS topics related to preoperative patient evaluation and preparation, airway management, and optimization of the major anesthetic and surgical goals. The authors identify and elaborate in detail on essential intraoperative considerations, such as the use of controlled hypotension and total intravenous anesthesia, discuss their advantages and disadvantages and provide practical recommendations for management. Lastly, the postoperative period for patients undergoing FESS is discussed with an emphasis on approaches that facilitate prompt hospital discharge with high patient satisfaction.
PURTSCHER'S‒LIKE RETINOPATHY SECONDARY TO GRANULOMATOSIS WITH POLYANGIITIS FOLLOWING AUTOLOGOUS STEM CELL TRANSPLANTATION
Authors: Hupy Matthew L. , Pecen Paula E. , Kolfenbach Jason R. , Lau Marissa , Palestine Alan G.
Published: April 2020

Purpose:

The authors describe a man undergoing autologous stem cell transplant, who developed granulomatosis with polyangiitis and Purtscher's‒like retinopathy.

Methods:

A 25-year-old man underwent fundus photography, optical coherence tomography, and fluorescein angiography to obtain a diagnosis and follow the treatment course.

Results:

The initial ophthalmic presentation and imaging confirmed the findings of Purtscher's‒like retinopathy. Throughout his course, he had progressive neovascularization and vitreous hemorrhages in both eyes, requiring vitrectomy and endolaser, and bevacizumab injections.

Conclusion:

The authors describe a patient who underwent autologous stem cell transplantation, and subsequently developed granulomatosis with polyangiitis. The presentation of Purtscher's‒like retinopathy suggests that microvascular occlusion in the retina was likely the result of granulomatosis with polyangiitis-driven vasculitis of the precapillary arterioles.
Time course of changes in anterior chamber structures after Nd:YAG laser anterior capsulotomy for early-onset postoperative capsular block syndrome evaluated by AS-OCT
Authors: Noda Kazunori , Nakanishi Hideo , Yoshikawa Munemitsu , Kurakazu Toshiaki , Sugimoto Yasuko , Minato Kazumi
Published: April 2020

A 69-year-old man underwent uncomplicated 25-gauge pars plana vitrectomy combined with phacoemulsification and intraocular lens (IOL) implantation for treatment of epiretinal membrane. On postoperative day 1, a shallow anterior chamber and an anterior displacement of the IOL with pigment dispersion were observed. Swept-source anterior segment optical coherence tomography (AS-OCT) revealed a capsular hyperexpansion with ciliochoroidal detachment, and the patient was diagnosed with early-onset postoperative capsular block syndrome (CBS). After peripheral anterior capsulotomy by Nd:YAG laser on postoperative day 1, the IOL displacement was resolved immediately, and a transient reverse pupillary block was detected by AS-OCT. A resolution of the reverse pupillary block and ciliochoroidal detachment was confirmed by AS-OCT on postoperative day 3. To our knowledge, this is the first case that describes the postoperative time course and a transient reverse pupillary block after Nd:YAG anterior capsulotomy for early postoperative CBS using swept-source AS-OCT images.
RE-KINECT
Authors: Caroff Stanley N. , Yeomans Karen , Lenderking William R. , Cutler Andrew J. , Tanner Caroline M. , Shalhoub Huda , Pagé Véronique , Chen Jun , Franey Ericha , Yonan Chuck
Published: April 2020

Purpose/Background

RE-KINECT (NCT03062033) was designed to assess the presence and impact of possible tardive dyskinesia (TD) in antipsychotic-treated outpatients.

Methods/Procedures

The study included adults with 3 or more months of lifetime antipsychotic exposure and 1 or more psychiatric disorder. Based on clinician observation and assessment, patients were assigned to cohort 1 (without involuntary movements or with non-TD involuntary movements) or cohort 2 (with involuntary movements confirmed by clinician as possible TD). Baseline assessments included the following: patient characteristics; location/severity of involuntary movements; and impact of possible TD on health-related quality of life, including the EuroQoL 5-Dimensions 5-Level questionnaire.

Findings/Results

Of 739 eligible patients, 204 (27.6%) had clinician-confirmed possible TD (cohort 2). Compared with cohort 1, patients in cohort 2 were significantly older (P < 0.0001), more likely to have schizophrenia or schizoaffective disorder (P < 0.0001) and longer lifetime exposure to antipsychotics (P < 0.0001), and less likely to be working or studying, based on clinician perception (P = 0.0010). Clinician- and patient-rated severity of possible TD movements was significantly correlated in each of 4 body regions (head/face, neck/trunk, upper extremities, lower extremities), for maximum severity in any region, and for total number of affected regions (P < 0.001 for all correlations). For the patient-rated EuroQoL 5-Dimensions 5-Level, the health state visual analog scale score was significantly lower (worse) in cohort 2 versus cohort 1 (66.8 vs 69.7; P = 0.0002), as was the utility index score (0.71 vs 0.76; P < 0.0175).

Implications/Conclusions

Results from this real-world population indicate that TD occurs frequently and can significantly reduce quality of life in patients with a psychiatric disorder.
Parents' Descriptions of Neonatal Palliation as a Treatment Option Prior to Periviable Delivery
Authors: Jager Shannon , Kavanaugh Karen , Hoffman Shelley , Laitano Tatiana , Jeffries Erin , Tucker Edmonds Brownsyne
Published: April 2020

During periviable deliveries, parents are confronted with overwhelming and challenging decisions. This study aimed to qualitatively explore the language that pregnant women and important others utilize when discussing palliation, or “comfort care,” as a treatment option in the context of periviability. We prospectively recruited women admitted for a threatened periviable delivery (22-25 weeks) at 2 hospitals between September 2016 and January 2018. Using a semistructured interview guide, we investigated participants' perceptions of neonatal treatment options, asking items such as “How was the choice of resuscitation presented to you?” and “What were the options presented?” Conventional content analysis was used and matrices were created to facilitate using a within- and across-case approach to identify and describe patterns. Thirty women and 16 important others were recruited in total. Participants' descriptions of treatment options included resuscitating at birth or not resuscitating. Participants further described the option to not resuscitate as “comfort care,” “implicit” comfort care, “doing nothing,” and “withdrawal of care.” This study revealed that many parents facing periviable delivery may lack an understanding of comfort care as a neonatal treatment option, highlighting the need to improve counseling efforts in order to maximize parents' informed decision-making.
A preliminary study on submariners with xerostomia after a 3-month deployment
Authors: Wang Guowei , Zhao Baodong , Kong Yujia , Ma DeXun , Yang Lin , Song Yingliang , Wang Xiaojing
Published: April 2020

To observe the clinical manifestations and salivary secretion of xerostomia patients in submariners who engaged in a three-month deployment. The general conditions and clinical examination of the 136 submariners were evaluated, by which the patients with xerostomia were screened out and their clinical manifestations were recorded. Besides, the flow rate of unstimulated saliva and stimulated saliva was measured and calculated. Subsequently, the related factors of xerostomia were quantitatively classified and statistically analyzed. In all the involved submariners, 42 were diagnosed to have xerostomia by physical examination after they returned from the task, among which 71.4% showed a decrease in unstimulated salivary flow rate and it was significantly correlated with the accompanying symptoms and their general conditions. Therefore, it was concluded that the occurrence of xerostomia could be related to the service life and job responsibilities of the submariners. The main manifestations were the reduction of unstimulated salivary secretion and the accompanying clinical symptoms such as cheilosis and angular cheilitis. Noticeably, the high psychological pressure and harsh living conditions need to be concerned, and further study should place more concentrations on these comprehensive influence factors and preventive actions of xerostomia.
Association between hypothyroidism and chronic kidney disease observed among an adult population 55 years and older
Authors: Huang Cheng-Wei , Li Bonnie H. , Reynolds Kristi , Jacobsen Steven J. , Rhee Connie M. , Sim John J.
Published: April 2020

Hypothyroidism and chronic kidney disease (CKD) are highly prevalent conditions with a potential mechanistic link. We sought to determine whether hypothyroidism is associated with CKD among a large diverse community-based cohort.

A cross-sectional study was performed (January 1, 1990–December 31, 2017) within a large integrated health system. Individuals age ≥55 years of age with outpatient measurements of thyroid stimulating hormone (TSH) and ≥2 serum creatinine values were included. Hypothyroidism was defined as TSH >4 mIU/L and/or receipt of thyroid hormone replacement and further categorized as hypothyroid status: TSH >4 mcIU/mL and attenuated-hypothyroid status: TSH <4 mcIU/mL with receipt of thyroid hormone replacement. Euthyroidism was defined as TSH <4 mIU/L and no thyroid hormone replacement. Our primary measure was CKD defined as an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2. Multivariable logistic regression adjusting for age, sex, race, and comorbidities was used to estimate odds ratios (OR) for CKD by thyroid status.

Among 378,101 individuals, 114,872 (30.4%) had hypothyroidism among whom 31,242 and 83,630 had hypothyroid and attenuated-hypothyroid statuses, respectively. Individuals with hypothyroidism had a CKD OR (95%CI) of 1.25 (1.21–1.29) compared with those with euthyroidism. Granular examination of thyroid statuses showed that hypothyroid and attenuated-hypothyroid statuses had CKD ORs (95% CI) of 1.59 (1.52–1.66) and 1.12 (1.08–1.16), respectively. A similar relationship was observed in analyses that defined CKD as an eGFR <60 L/min/1.73 m2.

Among individuals 55 years and older, we observed that those with hypothyroidism were more likely to have CKD. A stronger association was found among patients of hypothyroid status compared with attenuated-hypothyroid status suggesting a dose dependent relationship.
Unilateral percutaneous kyphoplasty for lumbar spine
Authors: Wang Hongwei , Hu Pan , Xu Weijie , Feng Ying , Zhang Yan , Zhu Yunpeng , Ren Weijian , Xiang Liangbi
Published: April 2020

Anatomical differences of unilateral percutaneous kyphoplasty (PKP) between transverse process-pedicle approach (TPPA) and conventional transpedicular approach (CTPA) are not well discussed. To investigate the anatomical distinctions of unilateral PKP between TPPA and CTPA, we have discussed the unilateral PKP through a 3-dimensional-computed tomography database.

Five hundred lumbar spines from 100 patients have been retrospectively collected and unilateral CTPA and TPPA were simulated. Distance between the entry point and the midline of the vertebral body (DEM), the puncture inclination angle (PIA), and the success rate (SR) of puncture were measured and compared.

The male presented with significantly larger DEM than the female. The TPPA group presented with larger DEM than the CTPA group according to different level, the difference was 1.5 ± 1.1 mm to 3.8 ± 2.3 mm. The PIAs in the TPPA group were larger than that in the CTPA group. The SR including 1 side SR and bilateral SR was 72.0% in the CTPA group and 98.0% in the TPPA group. Compared with CTPA group, the SR in TPPA group was significantly higher for L1 to L4 no matter in the left, right side and female patients.

The TPPA group presented with more lateral entry point, larger PIAs and higher SRs than that in the CTPA group. PKP surgery through a TPPA was safer and could provide a more symmetrical distribution of bone cement than the CTPA group.
Prior knee arthroscopy effects on subsequent total knee arthroplasty
Authors: Hu Feng , Chen Xulin , Wu Yingjie , Liu Wei
Published: April 2020

Background:

Currently, there exists a paucity of literature about the impact of prior knee arthroscopy on subsequent total knee arthroplasty (TKA). The purpose of this study was to compare outcomes of patients undergoing TKA after prior knee arthroscopy with a matched cohort of control subjects with primary osteoarthritis and no history of arthroscopy.

Methods:

We reviewed patients who underwent primary TKA at our academic center from January 2011 to December 2017. Of these, we included 68 patients (70 knees) that were performed TKA following knee arthroscopy. The groups were split by sex, age to within 6 years, and body mass index within 5 kg/m2. A 1:2 matching algorithm was applied. Outcome measures included surgical time, intraoperative estimated blood loss, Oxford Knee Score, range of movement, complications, and revision rate.

Results:

This study had limited inclusion and exclusion criteria and a well-controlled intervention.

Conclusion:

This clinical trial is expected to determine whether prior knee arthroscopy is associated with reduced functional outcomes or increased risks of revision and complications following TKA.

Trial registration:

This study protocol was registered in Research Registry (researchregistry5413).
What should be the timing of surgical treatment of humeral shaft fractures?
Authors: Yiğit Şeyhmus
Published: April 2020

This study aims to evaluate the timing of surgery in surgically treated humeral shaft fractures, to investigate the effects of surgical time on fracture recovery and complications.

This was a retrospective and observational study, based on patient data who underwent surgical treatment of humeral shaft fractures from January 2012 to January 2019. There were 52 patients (19 were women and 33 men) with traumatic humeral shaft fractures who were treated consecutively at our hospital.

There was a statistically significant difference in time to start physical therapy, time between surgery and bone union, and time between bone fracture and bone union. The mean time to start physical therapy in group 1 was 6.5 weeks (range, 5–12 weeks), it was 10 weeks (range, 6–14 weeks) in group 2 (P < .001). The mean time between surgery and bone union in group 1 was 14.58 weeks (range, 12–20 weeks), it was 17.4 weeks (range, 8–30 weeks) in group 2 (P: .009). The mean time between bone fracture and bone union in group 1 was 113.2 days (range, 86–114 days), it was 179.2 days (range, 89–355 days) in group 2 (P < .001).

Classically the first treatment option for humerus shaft fractures is conservative if there is no absolute surgical indication. Surgical treatment may be the first option if patients want to return to early everyday life. Delayed surgery means delayed physical therapy and this means delayed recovery and return to everyday life. In today's technology world, it should be discussed that the initial treatment of uncomplicated humerus shaft fractures is a conservative treatment.