bluuebunny/crossref_metadata_2025 huggingface dataset:
The Effects of the United States Medical Licensing Examination STEP 1 Pass/Fail Scoring Change for Obstetrics and Gynecology Residency Applicants [A58]
Authors: Girling Isabel C. , Burge Kaitlin G. , Haynes William , Patel Om U. , Yadav Ishant , Williams Audra R.
Published: June 2022

INTRODUCTION:

The National Board of Medical Examiners (NBME) recently approved the transition of the United States Medical Licensing Examination (USMLE) STEP 1 exam from a three-digit numeric scoring to a pass/fail format, effective January 26, 2022. The change will ideally result in a more holistic review of residency applicants, but the realized impacts remain to be seen. We aimed to examine the implications of the scoring change on future obstetrics and gynecology residency applicants.

METHODS:

Surveys were distributed to obstetrics and gynecology residency program directors (PD) for all 291 Accreditation Council for Graduate Medical Education-accredited residency programs. The survey assessed their viewpoints about the STEP 1 exam and asked respondents to rank the importance of variables used in assessment of potential applicants before and after the change to pass/fail. The survey was approved by the University of Alabama at Birmingham Institutional Review Board.

RESULTS:

We received 70 responses (response rate=24.0%). While most (60%) PDs believe that STEP 1 scores do not accurately predict a resident’s clinical performance, the majority (68.6%) disagreed that students will be better prepared clinically following the change to pass/fail. Clerkship grades were ranked as the most important variable in evaluating applicants both before and after the transition to pass/fail. Number of abstracts/presentations/publications and volunteer experiences saw the greatest increases in rank of importance with pass/fail as opposed to before.

CONCLUSION:

Despite the shortcomings of the STEP 1 exam in predicting clinical performance and the opportunity for more holistic review, obstetrics and gynecology PDs are skeptical of a transition to pass/fail scoring. The change will necessitate that alternative variables play a greater role in evaluation of residency applicants.
The Effect of Hogwarts House Teams and Competition on Resident Wellness, Resiliency, and Academic Participation [A65]
Authors: Chatfield Lindsay , Owens Amanda , Barbier Heather
Published: June 2022

INTRODUCTION:

The prevalence of burnout among US physicians is estimated to be 40-60%, which is higher than in workers in other fields. Additionally, obstetricians and gynecologists have one of the lowest resiliency scores compared to other medical specialties.

METHODS:

For the 2021-2022 academic year, the Walter Reed National Military Medical Center (Walter Reed) obstetrics and gynecology residents were divided into the four Hogwarts houses to take part in a year-long competition called the House Cup, during which they participate in monthly wellness challenges to earn points for their team. Additionally, residents are awarded points by demonstrating clinical excellence and outstanding work ethic. Quantitative data and qualitative feedback will be collected throughout the year to assess for feelings of wellness, burnout, and resiliency as well as academic participation.

RESULTS:

In a preintervention 2020 survey of Walter Reed obstetrics and gynecology residents, only 66% of residents believed our program had a culture of wellness. Interim data from a recent resident survey, with a response rate of 93.3% (14 of 15), showed that 84.7% (12 of 14) of residents believed our program has a culture of wellness, notably improved from last year. Additionally, 84.7% (12 of 14) of residents believed the House Cup has improved their resiliency, and 100% (14/14) of residents believed the House Cup has a positive impact on the program.

CONCLUSION:

Initial response to the House Cup competition has been overwhelmingly positive with residents reporting increased feelings of wellness and improved resiliency. Our goal is to create a sustainable, easy-to-implement initiative to improve resident wellness and resiliency not only at our program but across the country and across specialties.
Racial Disparity in Postoperative Pain Management following Laparoscopic Salpingectomies [A68]
Authors: Tsuei Angie , Swayze Emma , Tomassi Rachel , Linares Silvia
Published: June 2022

INTRODUCTION:

Previous literature in obstetrics has shown that racial biases influence postpartum pain management. Little is known about how these preconceptions affect opioid prescriptions in a post-operative setting. We compared the amount of morphine milligram equivalents (MME) prescribed to patients who identify as White and Black after a laparoscopic bilateral salpingectomy.

METHODS:

We conducted a retrospective chart review of 399 patients who underwent outpatient laparoscopic bilateral salpingectomies at Bronson Methodist Hospital in Kalamazoo between 2016 and 2021. Mean MMEs prescribed after surgery and maximum pain scores were compared between patients who identify as Black and White. Two-sided t-test was used to evaluate the data (significance at alpha 0.05). Maximum pain scores were calculated with the Mann-Whitney U test.

RESULTS:

25.8% (103/399) of our patient population self-identified as Black and 74.2% as White. The most commonly prescribed discharge pain medication for both groups was hydrocodone/acetaminophen, 55.6% and 51.7%, respectively. The median of max pain score (scale 0-10) of both groups was 6 (P=.63). The mean MME for White patients (n=256) was 37.6 (SD 14.7), while that of Black patients (n= 88) was 39.4 (17.4) with a P-value .3295. There was not a significant difference in pain scores by race within the first or last quartiles either.

CONCLUSION:

Our work serves as a model that clinical practices can utilize to evaluate current pain prescription practices and identify racial bias in pain management at an institutional level. Future studies with larger sample sizes are warranted to further explore this relationship.
The Influence of Care at a Large Regionalized Fetal Center on Patient Employment and Education [A70]
Authors: Gregory Emily , Abbasi Aleeza , Markham Kara B.
Published: June 2022

INTRODUCTION:

The Fetal Center (FC) at the University of Cincinnati Medical Center provides comprehensive fetal care for pregnancies complicated by fetal anomalies and genetic abnormalities. Many diagnoses require families to relocate to receive care. To date, no study has assessed the effect of fetal care on patient employment and education.

METHODS:

An anonymous survey was sent via email to patients who received care at our FC from 2015-2021. The survey included questions regarding demographics such as education and employment.

RESULTS:

74.2% of patients (95% CI 69.9-78.2) reported employment during pregnancy, with half reporting full-time employment (54.2%, CI 49.3-59). Nearly half reported missing 1-5 days of work related to their care at the FC (45.4%, CI 40.2-50.7) and more than one-third of women missed >10 days (37.4%, CI 32.4-42.7). Ninety percent of patient partners worked full time during the pregnancy (90.5%, CI 87.3-92.9), with similar work absences (44.3% missed 1-5 days, CI 39.4-49.3, and 32.6% missed >10 days, CI 28.2-37.5). Only 8% of patients (CI 5.8-10.9) were pursuing education during their pregnancies, 4/5 of whom were unable to continue (78.1%, CI 69.3-84.9). Overall, >40% of women reported a moderate to severe negative effect on their employment or education related to care at the FC (41.6%, CI 36.8-46.5).

CONCLUSION:

This study illuminates the barriers to continued employment and education that care at a tertiary FC imposes on patients and their partners. This may have significant financial implications for families who may already be contending with the costs of medical care for their child, and providers should be cognizant of the fiscal effects of their recommendations.
A Parasitic Leiomyoma of the Colon Leading to a Surgical Emergency in Pregnancy [A76]
Authors: Wilhoite Morgan N.
Published: June 2022

INTRODUCTION:

Uterine leiomyomas are the most common benign tumor of the reproductive tract. When a subserosal fibroid becomes adherent to another structure, the tumor sequesters blood supply from that structure and the pedicle on which the fibroid was once suspended either disappears or becomes avascular. This resultant tumor is termed a parasitic leiomyoma. Cases are few in which a parasitic fibroid develops without prior uterine surgery. The purpose of this case is to illustrate the workup and management of a parasitic leiomyoma causing bowel obstruction in a gravid patient naive to uterine surgery.

METHODS:

This is a case of a 26-year-old primigravid at 19 weeks gestation who presented with nausea, vomiting, and constipation, found to have a large colonic obstruction secondary to a presumed pedunculated uterine fibroid. The patient underwent an emergent laparotomy with plan for myomectomy. Intraoperatively, the mass was found to be entirely contained in the colonic mesentery, free of surrounding structures, without attachment to pelvic anatomy. General surgery was consulted to resect what was appeared to be a gastrointestinal stromal tumor (GIST) causing her obstruction. A partial colectomy and resection of the mass with end colostomy was performed. Histopathology confirmed a leiomyoma of uterine origin. The patient progressed through her pregnancy uncomplicated and went on to deliver vaginally at term.

CONCLUSION:

Parasitic leiomyomas can present in a variety of ways, including rarely as a bowel obstruction in a pregnant patient. This unusual situation should be included in the differential diagnosis when managing bowel pathology in pregnancy.
Bleeding Patterns in Women With Uterine Fibroids Receiving Relugolix Combination Therapy Over 1 Year [A78]
Authors: Lukes Andrea S. , Venturella Roberta , Al-Hendy Ayman , Zhu Emily Y. , Wagman Rachel , Stewart Elizabeth A.
Published: June 2022

INTRODUCTION:

In the institutional review board-approved LIBERTY 1 and 2 studies and long-term extension study, relugolix combination therapy (Relugolix-CT; once-daily relugolix 40 mg, estradiol 1 mg, norethindrone acetate 0.5 mg) improved uterine fibroid (UF)-associated heavy menstrual bleeding (HMB). We analyzed bleeding patterns and bleeding intensity reported in a daily diary through 52 weeks/end of treatment.

METHODS:

Menstrual blood loss (MBL) volume was quantified by the alkaline hematin method. Amenorrhea was defined as lack of bleeding for two consecutive visits (approximately 56 days). Bleeding pattern was defined as cyclic (3–12 days of bleeding with ≤2 consecutive non-bleeding days within the menstruation duration) or irregular (did not meet the definition of amenorrhea or cyclic bleeding). Bleeding intensity was categorized as MBL volume of ≤80mL (including spotting, light and moderate bleeding) or >80mL.

RESULTS:

In total, 163 women received relugolix combination therapy for up to 52 weeks. Of those, 70.6% reported amenorrhea. Smaller proportions of women reported cyclic or irregular patterns (9.2% and 20.2%, respectively). Of 15 patients with cyclic bleeding, nine experienced spotting or light/moderate bleeding (≤80mL) while five had >80mL and one had no data. Similar intensity was observed among 33 women with irregular bleeding (≤80mL [15 women], >80mL [10 women], and eight women had no data).

CONCLUSION:

The majority of women with UF-associated HMB who received relugolix combination therapy for up to 52 weeks achieved amenorrhea. Of the remaining women who had either cyclic or irregular bleeding, approximately half had spotting or light/moderate bleeding that was considered within the normal range for MBL (≤80mL).
Influence of Socioeconomic Factors on Surgical Wait Times for Elective Surgeries in Benign Gynecology [A81]
Authors: Kinsey Kelly Elizabeth T. , Brustman Lois , Dabney Lisa , Khalil Susan , Hardart Anne
Published: June 2022

INTRODUCTION:

In various disciplines, an association between patient outcomes and surgical wait times has been identified. This study provides the first investigation into whether practice setting influences wait times for elective surgeries in benign gynecology.

METHODS:

This retrospective study of patients at three Manhattan hospitals from October 2019 to February 2020 compared surgical wait times among patients seen in federally qualified health centers (FQHC) and private practice settings. Emergent surgeries, oncology cases, abortions, urogynecology procedures, and cases concurrently booked with another specialty were excluded. Surgical wait time was defined as the time (days) from the decision to operate to the day of procedure. A multivariable mixed model was used to model the log of surgical wait time by setting of care, adjusting for age, body mass index (BMI), race/ethnicity, insurance, need for medical clearance, and scheduled block time.

RESULTS:

A total of 540 patients were identified with a median age of 45.6 years (range 16-87 years). Average surgical wait time was 27 days (range 1-288 days). In multivariate analysis, longer surgical wait times were associated with the FQHC setting relative to private practice (70.9% longer, P=.006), and with needing medical clearance (36.8% longer, P=.02). Insurance type and race/ethnicity did not significantly impact surgical wait times in multivariate analysis. In univariate analysis, patients with public insurance had longer wait times compared with patients with commercial insurance (25% longer, P=.03).

CONCLUSION:

These results suggest that in benign gynecology, surgical wait times are significantly influenced by practice setting. Further research should investigate the reasons behind these preoperative delays with the goal of correcting inequities inherent in the medical system.
Long-Term Safety of Elagolix With Hormonal Add-Back Therapy in Women With Endometriosis-Associated Pain: 24-Month Results [A86]
Authors: Simon James , Kim Jin Hee , Thomas James , Miller Paul , Snabes Michael
Published: June 2022

INTRODUCTION:

Elagolix is an oral GnRH antagonist approved for the treatment of moderate to severe endometriosis-associated pain (EAP) in the US, Canada, and Israel. Hormonal add-back therapy (1 mg estradiol/0.5 mg norethindrone acetate QD) may alleviate the hypoestrogenic effects (including bone mineral density [BMD] loss) associated with elagolix. The long-term safety of elagolix 200mg BID+add-back are currently under investigation in an ongoing phase 3, 48-month (M) study for EAP; this report focuses on open label safety results to 24M.

METHODS:

Premenopausal women with moderate-to-severe EAP were initially randomized 4:1:2 to receive elagolix 200 mg BID+add-back, elagolix 200 mg BID, or placebo for 12M, followed by open-label elagolix 200 mg BID+add-back for 36M. This 24M analysis assessed long-term safety including BMD.

RESULTS:

BMD measurements remained stable during the open label treatment period. At 24M, mean percent change from baseline in BMD for patients who initially received elagolix 200 mg BID+add-back (n=123), elagolix 200 mg BID (n=29), or placebo (n=60) was −0.85%, −1.21%, and −0.43% (spine); −0.23%, −0.58%, and −0.20%, (total hip); and −1.05%, −0.98%, and 0.14% (femoral neck). During the open-label period, safety profiles were generally similar across all three original treatment groups at 24M; rates of serious adverse events were generally low (less than 5%) and balanced across groups.

CONCLUSION:

Elagolix 200 mg BID+add-back therapy for 24M continues to have a favorable safety profile with minimal long-term impact on BMD. Combined with previously reported improvements in dysmenorrhea and non-menstrual pelvic pain, these safety data suggest elagolix 200 mg BID+add-back may provide a longer-term therapeutic option for women with EAP.
Successful Identification of Mixed Vaginal Infections Requires Comprehensive Testing [A93]
Authors: Peacock Jacqueline , Carpenter Brittany L. , Dubiak Kyle , Fecteau Heather , Carlson Robert
Published: June 2022

INTRODUCTION:

Vaginitis is one of the most common gynecological complaints and carries an extremely high recurrence risk. Despite considerable symptomatic overlap, most testing and empirical treatment focus on anaerobic pathogens or Candida albicans infections. However, comprehensive testing of patients with recurrent vaginitis demonstrates a complex picture of mixed vaginitis and antimicrobial resistance.

METHODS:

Data from vaginitis cases released between April 2020 and May 2021 were reviewed. The comprehensive, PCR-based vaginosis panel includes pathogens associated with bacterial vaginosis and aerobic vaginitis, Candida spp., sexually transmitted infections (STIs), and Lactobacillus spp. While simultaneously detecting antibiotic resistance markers.

RESULTS:

A review of 9,534 cases revealed that 32.6% included pathogens unlikely to respond to empirical treatment; aerobic pathogens were detected in 26.5% of cases and STIs in 6.1%. STIs tested included Chlamydia trachomatis (2%), herpes simplex virus 1 or 2 (2%), Neisseria gonorrhoeae (0.6%), and/or Trichomonas vaginalis (1.8%). Mycoplasma genitalium, considered an emerging STI, was also detected in 0.9% of cases. Surprisingly, evidence of bacterial vaginosis was also present in 85% of STI positive cases. STI cases also represented a younger population. Evidence of antimicrobial resistance was frequent with macrolide-resistance genes detected in 40.2% of cases and fluconazole resistance detected in more than 20% of Candida positive cases.

CONCLUSION:

Mixed vaginitis cases are more common than expected and may partially explain the frequent recurrence rate of vaginitis. Clinical outcomes following comprehensive testing-guided treatment versus empirical treatment (e.g., 5-nitroimidazole agents) may warrant future study.
Laser Vaporization vs. Cystectomy in Women with Ovarian Endometrioma: A Systematic Review and Meta-analysis [A96]
Authors: Pivazyan Laura , Kasyan Victoria , Isaeva Sapiyat , Adamyan Leila
Published: June 2022

INTRODUCTION:

There are still many controversies about managing patients with ovarian endometrioma (OE), discussing recurrence rates, pregnancy rates, and reduction of ovarian reserve (OR). The objective of this study was to compare outcomes after laparoscopic cystectomy versus laser vaporization in women with OE.

METHODS:

A systematic review and meta-analysis was registered in PROSPERO (CRD42021281781) and was done according to the PRISMA 2020 checklist. Studies (published until October 2021) were identified by searching PubMed, Cochrane Library, Google Scholar, and ClinicalTrials databases (keywords "cystectomy," "laser vaporization," and "endometrioma"). Inclusion criteria: women of reproductive age undergoing surgery for OE larger than 30 mm. Outcomes-risk ratio for recurrence, ovarian reserve, and pregnancy rates. Tools recommended by the Cochrane Society achieved risk of bias assessment.

RESULTS:

In total, 874 studies were found, and nine studies were included in qualitative synthesis (822 patients). All of the authors compared the efficacy of cystectomy or laser vaporization in reproductive-aged women with OE. Overall risk of bias for randomized trials was 80% “some concerns” and 20% “low,” for cohort studies, 50% “some concerns” and 50% “low.” The primary meta-analysis focused on recurrence rates (four studies included in a meta-analysis) with no statistically significant difference found between these interventions (RR = 0.53, 95%CI: 0.24 to 1.21, P=.13). The next meta-analysis estimated antral follicle count (three studies) which was significantly lower in the cystectomy group (RR=-2.56, 95% CI: -3.71 to -1.42, P<.0001). Pregnancy rates were analyzed in three studies with no statistically significant difference (RR=0.96, 95% CI: 0.81 to 1.14, P=.64).

CONCLUSION:

There was no statistical difference in recurrence rate and pregnancy rates, butt antral follicle count was higher in the laser vaporization group. Nevertheless, we need more clinical trials for stronger recommendations.
Human Papillomavirus and Cervical Dysplasia in Latinas: Evaluating the Association Between HPV Infection and Cervical Dysplasia [A99]
Authors: Fanucchi Hannah , Naresh Amber
Published: June 2022

INTRODUCTION:

Given the elevated risk of cervical dysplasia and malignancy in the Latina population, we sought to assess the rate of high-grade cervical dysplasia in a population of Latina patients with human papillomavirus (HPV)-positive testing on screening Pap smear, relative to a non-Latina White population. We additionally assessed rates of HPV vaccination, HPV strains, and concordance of cytology/histology.

METHODS:

We conducted a retrospective chart review of all HPV-positive patients undergoing colposcopy across three clinics (January 2019 to September 2021), comparing demographic factors, medical history, cytology, HPV strains, and histology results between the groups. Logistic regression was performed to control for potential confounding factors.

RESULTS:

We identified 164 patients with positive HPV testing on Pap smear who completed histologic evaluation. No difference was seen in age, immunosuppression, prior abnormal Pap smears, or cytology between Latina and non-Latina patients. CIN2+ was identified in 57.6% of Latina patients, compared to 22.5% among non-Latina White individuals; P<.001. The significant difference persisted when controlling for tobacco use, HPV vaccination, immunosuppression and history of abnormal Pap smear. Latinas had less concordance between cytology and histology: 45.7% of Latinas had CIN2+ after initial low-grade cytology, compared to 7.7% of non-Latinas; P<.001.

CONCLUSION:

Among HPV-positive patients, Latina ethnicity was associated with increased risk of high-grade cervical dysplasia relative to non-Latina patients, despite no difference in initial cytology or other relevant medical factors. Latina ethnicity was additionally associated with lower HPV vaccination rates and decreased concordance of cytology and histology, with a higher rate of high grade histology following low-grade cytology.
Defining Limits of Postpartum Leukocytosis [A347]
Authors: Guarisco Elizabeth , Song Xuemei , Hartup Lindsay , Vargas Aleena , Barton Jordan , Belmonte Cosme , Holmes Cameron , Mattathil Shawna , Parker Brenna , Tami Claudina , Teague Jennifer , Wang Zhu , Boyd Angela
Published: June 2022

INTRODUCTION:

This study illustrates the rise in white blood cell value that can be reasonably expected after delivery and may give the physician further insight when evaluating postpartum patients with a leukocytosis.

METHODS:

This was a retrospective cohort study that examined data from January 1, 2018, to January 1, 2020. Women who delivered a live fetus at 37 weeks and 0 days gestational age or greater were included. Primary co-outcomes included defining the mean and >95th percentile white blood cell (WBC) count after delivery. Secondary outcomes included illustration of the change in predelivery WBC, hemoglobin (Hb), and hematocrit (Hct) values in the setting of certain characteristics. Extracted data included maternal age, gestational age, gravidity, parity, BMI (kg/m2), WBC value, Hb, and Hct prior to delivery and on postpartum day one. Data were analyzed using ANOVA, Student's t test, Mann-Whitney U test, and Wilcoxon rank sum test with a P<.05 indicating statistical significance.

RESULTS:

A total of 2,245 patients met the inclusion criteria, and of those, 1,476 delivered vaginally and 769 by cesarean delivery. The average change in WBC between the entry and postpartum WBC was 3.17 x 103/mm3. A WBC count greater than 19.07 x 103/mm3 was the 95th percentile. A significant difference in the rise in WBC when comparing vaginal delivery to cesarean delivery was observed (3.44 vs 2.64 x 103/mm3, P<.001). Patients diagnosed with suspected peripartum infection had a greater postpartum day-one WBC (7.24 vs 2.98 x 103/mm3, P<.001), as did those who received additional uterotonics (P<.001). There was an increase in WBC value with worsening degree of maternal tear after vaginal delivery (P<.001). There was no significant difference in WBC when comparing hypertensive disorders of pregnancy or diabetes.

CONCLUSION:

A paucity of data exists on the ultimate effect of delivery on changes in WBC indices when considering delivery characteristics and maternal co-morbidities. A boxplot was created to illustrate these values.
The effectiveness and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early-stage human epidermal growth factor receptor 2-positive breast cancer: Turkish Oncology Group study
Authors: Özdemir Özlem , Zengel Baha , Yildiz Yaşar , Uluç Basak Oyan , Cabuk Devrim , Ozden Ercan , Salim Derya Kivrak , Paydas Semra , Demir Atakan , Diker Omer , Pilanci Kezban Nur , Sönmez Özlem Uysal , Vatansever Sezai , Dogan Izzet , Gulmez Ahmet , Cakar Burcu , Gursoy Pinar , Yildirim Mahmut Emre , Ayhan Murat , Karadurmus Nuri , Aykan Musa Baris , Cevik Gökcen Tugba , Sakalar Teoman , Hacibekiroglu Ilhan , Gülbagci Burcu Belen , Dincer Murat , Garbioglu Duygu Bayir , Kemal Yasemin , Nayir Erdinc , Taskaynatan Halil , Yilmaz Mesut , Avci Okan , Sari Murat , Coban Ezgi , Atci Muhammed Mustafa , Esen Selin Aktürk , Telli Tugba Akin , Karatas Fatih , Inal Ali , Demir Hacer , Kalkan Nurhan Onal , Yilmaz Cengiz , Tasli Funda , Alacacioglu Ahmet
Published: June 2022

In our study, we aimed to evaluate the pathological response rates and side effect profile of adding pertuzumab to the treatment of HER2+ locally advanced, inflammatory, or early-stage breast cancer. This study was conducted by the Turkish Oncology Group (TOG) with data collected from 32 centers. Our study was multicentric, and a total of 364 patients were included. The median age of the patients was 49 years (18–85 years). Two hundred fifteen (60%) of the cases were hormone receptor/HER2+ positive(ER+ or PR+, or both), and 149 (40%) of them were HER2-rich (ER and PR negative). The number of complete responses was 124 (54%) in the docetaxel+trastuzumab+pertuzumab arm and 102 (45%) in the paclitaxel+trastuzumab+pertuzumab arm, and there was no difference between the groups in terms of complete response. In 226 (62%) patients with complete response, a significant correlation was found with DCIS, tumor focality, removed lymph node, and ER status P < 0.05. Anemia, nausea, vomiting, myalgia, alopecia, and mucosal inflammation were significantly higher in the docetaxel arm, P < 0.05. In our study, no statistical difference was found between the before–after echocardiography values. DCIS positivity in biopsy before neoadjuvant chemotherapy, tumor focality; the number of lymph nodes removed and ER status were found to be associated with pCR. In conclusion, we think that studies evaluating pCR-related clinicopathological variables and radiological imaging features will play a critical role in the development of nonsurgical treatment approaches.
Association of Illness Severity With Family Outcomes Following Pediatric Septic Shock
Authors: Killien Elizabeth Y. , Zimmerman Jerry J. , Di Gennaro Jane L. , Watson R. Scott
Published: June 2022

IMPORTANCE:

It is unknown which families are at risk for poor outcomes following a child’s critical illness.

OBJECTIVES:

To evaluate if pediatric septic shock severity is associated with caregiver distress and family dysfunction throughout the year postadmission and if caregiver outcomes are associated with child health-related quality of life (HRQL).

DESIGN, SETTING, AND PARTICIPANTS:

Secondary analysis of the Life After Pediatric Sepsis Evaluation prospective cohort study among children less than 18 years old with community-acquired septic shock requiring vasoactive-inotropic support and invasive or noninvasive ventilation in 12 academic U.S. PICUs.

MAIN OUTCOMES AND MEASURES:

Caregivers reported personal psychologic distress (Brief Symptom Inventory), family functioning (Family Assessment Device), and child HRQL (Pediatric Quality of Life Inventory, Functional Status II-Revised) at baseline and 1, 3, 6, and 12 months following PICU admission.

RESULTS:

Among 276 caregivers, psychologic distress prevalence initially decreased then rose to 15.3%, whereas prevalence of family dysfunction increased steadily to 30.9% at 12 months. On multivariable logistic regression adjusting for patient age, medical complexity, and immunosuppression, higher Pediatric Risk of Mortality and vasoactive-inotropic scores and longer PICU and hospital stay were associated with greater caregiver distress at 1 month. Higher Pediatric Logistic Organ Dysfunction (PELOD) score, longer ventilation, and longer PICU stay were associated with lower odds of family dysfunction at 1, 3, and 6 months (average PELOD vs new 6-mo dysfunction: odds ratio [OR], 0.73 [95% CI, 0.55–0.96]). Caregiver distress was associated with child HRQL decline from baseline to 1 month (OR, 2.92 [1.27–6.75]), 3 months (OR, 2.34 [1.01–5.42]), and 12 months (OR, 3.94 [1.54–10.06]).

CONCLUSIONS AND RELEVANCE:

Family dysfunction becomes increasingly prevalent over the year following pediatric septic shock and is less likely following higher severity illness. Caregiver psychologic distress is associated with worse child HRQL. Both patients and families may benefit from ongoing psychosocial support following survival from pediatric septic shock.
Congestive heart failure and sepsis: a retrospective study of hospitalization outcomes from a rural hospital in Southwest Missouri
Authors: Skovran Alexandra , Hinke Mason , Sloan Shelly N. B. , Stahl Greg , Johnson Kerry , Goade Scott , Arnce Robert
Published: June 2022

Background

Sepsis is the leading cause of death in hospitalized patients and significant effort has been made to facilitate early diagnosis and management. However, aggressive treatment can have negative effects, especially in patients with unstable volume status, such as those with congestive heart failure.

Methods

We used electronic medical records to perform a retrospective study looking at hospital outcomes in patients from Southwest Missouri who were admitted with sepsis and had a comorbid diagnosis of hypertensive heart failure. Our primary outcome was in-hospital mortality.

Results

We studied a total of 184 patients with the diagnosis of hypertensive heart failure with sepsis, and 348 patients with the diagnosis of sepsis that served as the baseline group. There was a total of 37 (20%) deaths in the hypertensive heart failure group and a total of 94 (27%) deaths in the baseline group.

Conclusion

Our study showed no significant difference between the baseline group and those with hypertensive heart disease with heart failure.
Orthostatic hypotension and mortality risk in geriatric outpatients: the impact of duration and magnitude of the blood pressure drop
Authors: Wiersinga Julia H.I. , Muller Majon , Rhodius-Meester Hanneke F.M. , De Kroon Renske M. , Peters Mike J.L. , Trappenburg Marijke C.
Published: June 2022

Introduction:

Orthostatic hypotension is a common condition associated with an increased mortality risk. This study investigates this association specifically in geriatric outpatients and additionally focuses on the duration and magnitude of orthostatic hypotension.

Methods:

In this observational prospective cohort study with geriatric outpatients from the Amsterdam Ageing cohort, we differentiated orthostatic hypotension in early orthostatic hypotension (EOH) and delayed/prolonged orthostatic hypotension (DPOH). The magnitude of drop in both SBP and DBP after either 1 or 3 min was quantified. Mortality data was obtained from the Dutch municipal register. Cox proportional hazard models were used to determine the association between orthostatic hypotension and mortality, adjusted for sex and age (model 1), additionally adjusted for orthostatic hypotension-inducing drugs + SBP (model 2) and the presence of cardiovascular disease and diabetes (model 3). Stratified analyses in patients with geriatric deficits were performed.

Results:

We included 1240 patients (mean age 79.4 ± 6.9 years, 52.6% women). Prevalence of orthostatic hypotension was 443 (34.9%); 148 (11.9%) patients had EOH and 285 (23%) DPOH. DPOH was associated with a higher mortality risk [hazard ratio, 95% CI 1.69 (1.28–2.22)] whereas EOH was not associated with mortality risk. This association did not differ in patients with geriatric deficits. Furthermore, the magnitude of drop in both SBP and DBP was associated with a higher mortality risk.

Conclusion:

The presence of DPOH and the magnitude of both systolic and diastolic orthostatic hypotension are related to an increased mortality risk in geriatric outpatients. Whether the duration of orthostatic hypotension and magnitude of the drop in blood pressure is causally related to mortality risk or whether it is a sign of decreased resilience remains to be elucidated.
Association between genetic risk of high SBP and hypertension control: the CoLaus|PsyColaus study
Authors: Marques-Vidal Pedro , Chekanova Valeriya , Vaucher Julien
Published: June 2022

Objective:

To assess whether a genetic risk score (GRS) for high SBP is associated with poor control of hypertension.

Methods:

Data from the four waves of a population-based, prospective study conducted in Lausanne, Switzerland. Control of hypertension was defined based on SBP less than 140 mmHg and DBP less than 90 mmHg. A weighted GRS was computed from 362 SNPs.

Results:

Overall, 1097 (51% men, mean age 61 years), 1126 (53% men, age 65 years), 1020 (52% men, age 69 years) and 809 (50% men, age 71 years) participants treated for hypertension were selected from the baseline (2003–2006), first (2009–2012), second (2014–2017) and third (2018–2021) surveys. Hypertension control rates were 50, 58, 52 and 59% for the baseline, first, second and third surveys, respectively. No association was found between GRS and hypertension control: multivariate-adjusted mean ± standard error for controlled vs. uncontrolled participants: 9.30 ± 0.09 vs. 9.50 ± 0.09 (P = 0.12); 9.32 ± 0.08 vs. 9.53 ± 0.10 (P = 0.10); 9.17 ± 0.08 vs. 9.34 ± 0.11 (P = 0.22), and 9.18 ± 0.09 vs. 9.46 ± 0.11 (P = 0.07) for the baseline, first, second and third surveys, respectively. Power analysis showed that a minimum of 3410 people treated for hypertension would be necessary to detect an association between the GRS and hypertension control rates. Notably, positive associations between the GRS and SBP levels were found among participants not treated for hypertension, with Spearman correlations ranging between 0.05 and 0.09 (all P < 0.05).

Conclusion:

Using a GRS associated with SBP levels is not predictive of hypertension control. The use of GRS for hypertension management is not warranted in clinical practice.

Graphical abstract:

http://links.lww.com/HJH/C26
Household Secondary Transmission of the Severe Acute Respiratory Syndrome Coronavirus 2 Alpha Variant From a Community Cluster in a Nursery in Japan
Authors: Ikuse Tatsuki , Aizawa Yuta , Shobukawa Yugo , Tomiyama Nobuko , Nakayama Hitoshi , Takahashi Masako , Muto Kensuke , Hasegawa Satoshi , Takahashi Masashi , Kon Miyako , Tamura Tsutomu , Matsumoto Haruki , Saito Reiko , Saitoh Akihiko
Published: June 2022

Background:

Spread of variants of concerns (VOCs) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to an increase in children with coronavirus disease 2019 (COVID-19). In February 2021, clusters of the Alpha variant of SARS-CoV-2 started to be reported in Niigata, Japan, including a large nursery cluster. We investigated the transmission routes and household secondary attack rates (SARs) in this cluster.

Methods:

Epidemiologic data related to a nursery cluster in Niigata, Japan, particularly child-origin and adult-origin SARs, were analyzed. VOCs were confirmed by whole-genome sequencing of virus from patients.

Results:

In total, 42 persons (22 children and 20 adults) in the cluster were infected with the Alpha variant. In the nursery, 13 of 81 children (16.0%) and 4 of 24 teachers (16.7%) were infected. SARS-CoV-2 later spread to 25 persons (10 children and 15 adults) outside the nursery. Child-origin and adult-origin household SARs were 27.7% (13/47) and 47.0% (8/17) (P = 0.11), respectively, which were higher than rates attributable to non-VOCs in previous studies.

Conclusions:

As compared with non-VOCs, the Alpha variant of SARS-CoV-2 exhibited high transmissibility among children and adults and may pose a high risk for household secondary transmission from SARS-CoV-2–infected children. Increased transmissibility of current or future VOCs could lead to greater transmission from children to adults or other children.
Prostate Cancer Classification Using Artificial Neural Networks
Authors: Abdallah Souheir A. , Mustafa Zeinab A. , Ibraheem Banazier A.
Published: June 2022

Prostate cancer is one of the major causes of cancer death in men in the Western world. One in 6 men will develop prostate cancer in his lifetime. Early detection and accurate diagnosis of the disease can improve cancer survival and reduce treatment costs [Computer-aided detection of prostate cancer in MRI. IEEE, May 2014]. The artificial neural network (ANN) is used to classify and extract the feature of the magnetic resonance imaging (MRI) scan. This classification is computer-based and has the advantage that it enriches the patient from the doctor and undergoes the different diagnostic techniques that may appear to be stressful and painful. A computer-aided classification set of MRI scans of the prostate subjects these images to a set of preprocessing and image enhancement giving an accurate classification to improve the properties of the image such as noise filtering to improve the contrast of the image and then using segmentation to separate the tumor region and feature extraction; this step can be done by using a set of rolls (explained below). This feature is used to input data to ANN. It classifies the given data set into benign or malignant (prostate cancer). The system succeeded in classifying malignant tumors with 92.4%, increasing decision-making and providing particular treatment. The computerized method detects the tumor in its early stage; thus, good classification is an essential part. The first stage is to extract features from MRI using principal component analysis (computer aided diagnosis), and the second stage is to train the probabilistic neural network (ANN) for classification. The computer aided diagnosis method gives existing attributes a new set of calculated parameters.
Development of a Fully Automated Method to Obtain Reproducible Lymphocyte Counts in Patients With Colorectal Cancer
Authors: Fiehn Anne-Marie K. , Reiss Bjoern , Gögenur Mikail , Bzorek Michael , Gögenur Ismail
Published: June 2022

Colorectal cancer (CRC) is the third most common cancer worldwide. Although clinical outcome varies among patients diagnosed within the same TNM stage it is the cornerstone in treatment decisions as well as follow-up programmes. Tumor-infiltrating lymphocytes have added value when evaluating survival outcomes. The aim of this study was to develop a fully automated method for quantification of subsets of T lymphocytes in the invasive margin and central tumor in patients with CRC based on Deep Learning powered artificial intelligence. The study cohort consisted of 163 consecutive patients with a primary diagnosis of CRC followed by a surgical resection. Double-labeling immunohistochemical staining with cytokeratin in combination with CD3 or CD8, respectively, was performed on 1 representative slide from each patient. Visiopharm Quantitative Digital Pathology software was used to develop Application Protocol Packages for visualization of architectural details (background, normal epithelium, cancer epithelium, surrounding tissue), identification of central tumor and invasive margin as well as subsequent quantitative analysis of immune cells. Fully automated counts for CD3 and CD8 positive T cells were obtained in 93% and 92% of the cases, respectively. In the remaining cases, manual editing was required. In conclusion, the development of a fully automated method for counting CD3+ and CD8+ lymphocytes in a cohort of patients with CRC provided excellent results eliminating not only observer variability in lymphocyte counts but also in identifying the regions of interest for the quantitative analysis. Validation of the performance of the Application Protocol Packages including clinical correlation is needed.
Provider Perspectives on Factors Affecting the PrEP Care Continuum Among Black Cisgender Women in the Midwest United States: Applying the Consolidated Framework for Implementation Research
Authors: Johnson Amy K. , Pyra Maria , Devlin Samantha , Uvin A. Ziggy , Irby Shemeka , Blum Cori , Stewart Eric , Masinter Lisa , Haider Sadia , Hirschhorn Lisa R. , Ridgway Jessica P.
Published: June 2022

Background:

To End the HIV Epidemic and reduce the number of incident HIV infections in the United States by 90%, pre-exposure prophylaxis (PrEP) uptake and persistence among cisgender women, particularly racial and ethnic minority women, must be increased. Medical providers play a pivotal role across the PrEP care continuum.

Methods:

In this qualitative study, guided by the Consolidated Framework for Implementation Research, we explored health care provider perspectives on facilitators and barriers to PrEP implementation strategies for Black cisgender women in the Midwest United States. Data were analyzed using a deductive thematic content analysis approach.

Results:

A total of 10 medical providers completed individual qualitative interviews. Using the Consolidated Framework for Implementation Research framework, we identified intervention characteristics (cost, dosing, and adherence), individual patient and provider level factors (self-efficacy, knowledge, and attitudes), and systematic barriers (inner setting and outer setting) that ultimately lead to PrEP inequalities. Implementation strategies to improve the PrEP care continuum identified include provider training, electronic medical record optimization, routine patient education, and PrEP navigation.

Conclusion:

This study provides (1) medical provider insight into implementation factors that can be modified to improve the PrEP care continuum for Black cisgender women and (2) an implementation research logic model to guide future studies.
Board Certification in Cosmetic Surgery
Authors: Chen Shirley , Makhoul Alan T. , Janis Jeffrey E. , Perdikis Galen , Drolet Brian C.
Published: June 2022

Background

Aesthetic surgery patients commonly use online resources to select a surgeon. The American Board of Plastic Surgery is the American Board of Medical Specialties member board that certifies plastic surgeons. The American Board of Cosmetic Surgery (ABCS) provides aesthetic surgery credentials through a non–American Board of Medical Specialties–recognized process. This study examines use of the phrases “plastic surgery” and “plastic surgeon” by ABCS-certified surgeons when advertising online.

Methods

Diplomates of the ABCS were identified from the ABCS Web site. Professional Web sites, Facebook business pages, and Instagram profiles were located by online search. Use of the descriptor “plastic” and ABCS board certification on practice Web sites, Facebook business page categorization, and plastic surgery–related hashtag use on Instagram were recorded.

Results

A total of 298 non–American Board of Plastic Surgery–certified ABCS diplomates were included. One hundred eighty-nine (69.5%) categorized their Facebook business page as “plastic surgeon.” Within Instagram posts, 123 (57.2%) used #plasticsurgeon, and 172 (80.0%) used #plasticsurgery. On professional Web sites, 90 (30.4%) identified themselves as a “plastic surgeon,” 123 (41.6%) characterized their practice as “plastic surgery,” and 196 (68.5%) used their ABCS credential to identify as a “board-certified” cosmetic surgeon.

Conclusions

Diplomates of the ABCS frequently use “plastic surgeon” and “plastic surgery” in online advertisements despite a lack of accredited plastic surgery training or board certification. Furthermore, most ABCS diplomates use their ABCS credentials to market themselves as “board-certified” cosmetic surgeons, potentially violating American Medical Association–supported truth in advertising laws in some states and increasing public confusion regarding different board certifications.
Gender-Affirming Surgeries
Authors: Scott Kiandra B. , Thuman Jenna , Jain Abhishek , Gregoski Matthew , Herrera Fernando
Published: June 2022

Background

Gender affirmation surgery is an exponentially growing field within plastic surgery. The aim of our study is to analyze demographics, procedure type, trends, and outcomes in the surgical management of gender identity disorder in the past few years.

Methods

The American College of Surgeons NSQIP database was queried for the years 2015 to 2019. International Classification of Diseases codes were used to identify all gender-affirming cases. Patients were categorized by procedure type using Current Procedural Terminology codes for feminizing/masculinizing top, bottom and head/neck procedures. Patient demographics, comorbidities, and postoperative complications were analyzed using SPSS statistics software. A comparative analysis was performed among the procedure type.

Results

From 2015 to 2019, 4114 patients underwent a gender-affirming surgery (GAS) increasing the number of surgeries by over 400%, according to the NSQIP database. Demographics include age (mean = 32 years), body mass index (mean = 28 kg/m2), race (60% White, 22% unknown, 13% African American, 4% Asian, 1% other). Female to male procedures represented the most commonly performed (n = 2647; 64%), followed by male to female (n = 1278; 31%) with head/neck procedures representing 5% (n = 189) of all procedures. Top surgeries were also the most common (n = 2347, 57%), followed by bottom surgeries (n = 1578, 38%). The overall complication rate was 6% (n = 247), 2.1% (n = 4) for head/neck procedures, 8% (n = 134) for bottom procedures, and 3.5% (n = 84) for top surgeries.

A reoperation within 30 days and related to the initial GAS occurred for 52 patients. Postoperative complication rates were statistically different between bottom surgeries compared with the top and head/neck procedure groups (P < 0.001). Increasing age and body mass index showed a significantly higher odds of having a complication.

Conclusions

Gender-affirming procedures have significantly increased over the past 5 years. Increased exposure through literature and research, as well as an improvement in social climates, including increasing insurance coverage have contributed to the expansion of these procedures. Low serious complication rates within 30 days prove GAS to be safe.