bluuebunny/crossref_metadata_2025 huggingface dataset:
Using Music to Address Trauma with Refugees: A Systematic Review and Recommendations
Authors: Bernard Gabriella , Dvorak Abbey L
Published: June 2022

Refugees experience trauma and are more vulnerable than the general population to experiencing mental health conditions. Music may be used to support and enhance the lives of refugees. The purpose of this systematic review was to summarize and describe the uses of music to address trauma for individuals who are refugees. The research questions included (a) What are the characteristics of studies using music to address trauma for people who are refugees? and (b) What are the outcomes of these studies, and how are these outcomes measured? The researchers gathered available literature from PsycInfo, ERIC, Sociological Abstracts, PubMed, Music Index, and Directory of Open Access Journals (DOAJ). Databases were searched using “music” AND “refugee.” Search filters aimed to select articles that were peer-reviewed and published quantitative, qualitative, or mixed-methods studies. Of the 1,318 studies first identified, 11 met the criteria for inclusion. Studies included qualitative and quantitative approaches; the most common research design was case study. The majority of participants were adult refugees from a variety of countries, with approximately a third of the studies conducted in Australia. The majority of interventionists identified as music therapists. Treatment length varied from several days to 18 months, typically occurring once or twice weekly. Music interventions included a combination of methods, with receptive and recreative most common. Outcomes included improvements in behavioral and psychological functioning, with a variety of measurement tools used. Implications and recommendations for music therapy clinical practice are discussed.
Diversity within the neurosurgical oncology workforce in the United States: A cross-sectional study with proposed strategies to pave the path forward
Authors: Asfaw Zerubabbel Ketema , Rodriguez Analiz , Hodges Tiffany Renee , Mazumdar Madhu , Zhan Serena , Lim Michael , Germano Isabelle Margherita
Published: June 2022

Background

Improving and fostering diversity within the neurosurgical workforce has become a high priority. This cross-sectional study aims to provide data on the diversity of neurosurgical oncology faculty (NSOF) in the US.

Methods

All 115 neurosurgery (NS) Accreditation Council for Graduate Medical Education (ACGME) accredited programs were included in this study. The academic rank, academic and clinical title(s), gender, race, and hiring date of neurosurgical faculty with a primary focus on neurosurgical oncology (NSOF) were recorded. Geographical distribution and “top 10” programs were tabulated according to published data. Underrepresented minorities in medicine (URiM) faculty were identified according to the AAMC definition.

Results

The NSOF workforce constitutes 21% of the total NS faculty. Of these, 10.1% are women and 9.9% are URiM (P < .001). Currently, 58% of neurosurgery programs (NSP) do not have URiM and/or women NSOF. The top 10 ranked NSP, according to Blue Ridge Institute for Medical Research, had a significantly less URiM NSOF (P = .019) than nontop 10 ranked programs. There was a decreasing trend in the proportion of URiM at higher academic ranks (P = .019). All of the URiM department chairs (3/113)—all men—and 1/3 women department chairs nationwide subspecialized in neurosurgical oncology.

Conclusions

Neurosurgical oncology is a sought-after subspecialty attracting a fifth of neurosurgeons practicing in ACGME-accredited training programs. Changing demographics and the benefits of workforce diversity represent a great opportunity for our field to continue leading inclusion efforts and attracting the best and brightest.
Pharmacologic Management of Mycobacterium chimaera Infections: A Primer for Clinicians
Authors: Mason Matt , Gregory Eric , Foster Keith , Klatt Megan , Zoubek Sara , Eid Albert J
Published: June 2022

Mycobacterium chimaera, a member of the Mycobacterium avium complex, can cause infections in individuals after open heart surgery due to contaminated heater-cooler units. The diagnosis can be challenging, as the incubation period can be quite variable, and symptoms are nonspecific. In addition to aggressive surgical management, combination pharmacologic therapy is the cornerstone of therapy, which should consist of a macrolide, a rifamycin, ethambutol, and amikacin. Multiple second-line agents may be utilized in the setting of intolerances or toxicities. In vitro susceptibility of these agents is similar to activity against other species in the Mycobacterium avium complex. Drug–drug interactions are frequently encountered, as many individuals have chronic medical comorbidities and are prescribed medications that interact with the first-line agents used to treat M. chimaera. Recognition of these drug–drug interactions and appropriate management are essential for optimizing treatment outcomes.
Timing of Patient Management Decisions Relative to Echocardiography in Staphylococcus aureus Bacteremia: A Single-Center Retrospective Analysis
Authors: Aldred Bruce , Drekonja Dimitri Maximilian
Published: June 2022

Background

In patients with Staphylococcus aureus bacteremia (SAB), endocarditis evaluation includes transthoracic echocardiography (TTE) and, in patients at increased risk of endocarditis, subsequent transesophageal echocardiography (TEE). Whether performing TTE before TEE influences clinicians’ decision making has not been well studied in patients deemed to warrant TEE.

Methods

In this retrospective case series, we studied clinician behavior at a large Veterans Affairs medical center regarding the care of adult patients diagnosed with SAB who completed both TTE and TEE (n = 206 episodes of SAB). The timing of key patient management decisions was compared to the timing of the patient’s TTE and TEE. It was inferred whether each management decision could have been informed by TTE alone versus TTE plus subsequent TEE. Management decisions included the following: documentation of antibiotic treatment duration, initiation of synergistic antibiotics, consultation of relevant specialists, ordering of relevant imaging studies, and performance of valve surgery or cardiac device explanation.

Results

The primary outcome (any of the above 5 management decisions taking place) occurred after completion of TTE but before TEE in 13 SAB episodes (6.3%). The primary outcome occurred after completion of both TTE and TEE in 178 SAB episodes (86.4%). Documentation of antibiotic treatment duration accounted for the large majority of observed management decisions.

Conclusions

Among patients with SAB who are deemed to warrant TEE for endocarditis evaluation, TTE results alone rarely prompt clinical management decisions.
Comorbidities and use of analgesics in people with knee pain: a study in the Nottingham Knee Pain and Health in the Community (KPIC) cohort
Authors: Swain Subhashisa , Fernandes Gwen Sascha , Sarmanova Aliya , Valdes Ana M , Walsh David A , Coupland Carol , Doherty Michael , Zhang Weiya
Published: June 2022

Objectives

The aims were to examine the prevalence of comorbidities and role of oral analgesic use in people with knee pain (KP) compared with those without.

Methods

The Knee Pain and related health In the Community (KPIC) cohort comprises community-derived adults aged ≥40 years, irrespective of knee pain. Thirty-six comorbidities across 10 systems were compared between people with KP and controls without KP or knee OA. Multivariable logistic regression analysis was used to determine the adjusted odds ratio (aOR) and 95% CI for multimorbidity (at least two chronic conditions) and each specific comorbidity. Both prescribed and over-the-counter analgesics were included in the model, and their interactions with KP for comorbidity outcomes were examined.

Results

Two thousand eight hundred and thirty-two cases with KP and 2518 controls were selected from 9506 baseline participants. The mean age of KP cases was 62.2 years, and 57% were women. Overall, 29% of the total study population had multimorbidity (KP cases 34.4%; controls 23.8%). After adjustment for age, sex, BMI and analgesic use, KP was significantly associated with multimorbidity (aOR 1.35; 95% CI 1.17, 1.56) and with cardiovascular (aOR 1.25; 95% CI 1.08, 1.44), gastrointestinal (aOR 1.34; 95% CI 1.04, 1.92), chronic widespread pain (aOR 1.54; 95% CI 1.29, 1.86) and neurological (aOR 1.32; 95% CI 1.01, 1.76) comorbidities. For multimorbidity, the use of paracetamol and opioids interacted positively with KP, whereas the use of NSAIDs interacted negatively for seven comorbidities.

Conclusion

People with KP are more likely to have other chronic conditions. The long-term benefits and harms of this change remain to be investigated.

Trial registration

ClinicalTrials.gov, http://clinicaltrials.gov, NCT02098070.
Oral supplementation of alkaline phosphatase in poultry and swine
Authors: Escobar Jeffery , Dobbs Merilyn , Ellenberger Claudia , Parker Alysia , Latorre Juan D , Gabor Leslie
Published: June 2022

The importance of intestinal alkaline phosphatase (IAP) in maintaining gut health and intestinal homeostasis is well established. The objective of this study was to investigate the tolerance of poultry and swine to dietary supplementation of a novel microbial-derived alkaline phosphatase (AP; E.C. 3.1.3.1 produced by Paenibacillus lentus strain CMG3709). Studies were conducted on day-old Ross 308 chicken (n = 1,000; Study 1) and weaned piglets (n = 180; Study 2) for a duration of 42 d; and consisted of four treatment groups (TG) based on the concentration of microbial-derived AP supplemented in their diet at 0; 12,000; 20,000; and 200,000 U/kg of feed. Parameters such as animal survival, hematology, coagulation, and biochemical indices were assessed at the end of the study. The effect of microbial AP on nutrient absorption through skin pigmentation and intestinal permeability were also investigated in broilers (n = 600; Study 3). In poultry (Study 1), there were no statistically significant differences between control and TG for any of the hematological and biochemical parameters, except for a marginal increase (P < 0.05) in serum phosphorus at the highest dose. This variation was not dose-dependent, was well within the reference range, and was not associated with any clinical correlates. In swine (Study 2), hematological parameters such as leukocyte, basophil, and lymphocyte counts were lower (P < 0.05) for the two highest doses but were traced back to individual variations within the group. The biochemical indices in piglets showed no significant differences between control and supplemental groups except for glucose (P = 0.0005), which showed a high effect (P = 0.008) of the random blood collection order. Nonetheless, glucose was within the normal reference range, and were not related to in-feed supplementation of AP as they had no biological significance. The survival rate in all three studies was over 98%. Dietary supplementation of microbial-derived AP up to 16.7 times the intended use (12,000 U/kg feed) level had no negative effects in both poultry and swine. In-feed supplementation of microbial-derived AP for 28 d improved intestinal pigment absorption (P < 0.0001) and reduced intestinal paracellular permeability (P = 0.0001) in broilers (Study 3). Based on these results, it can be concluded that oral supplementation of microbial-derived AP is safe for poultry and swine and effective at improving gut health in poultry.
Berberine Bridge Enzyme-like Oligosaccharide Oxidases Act as Enzymatic Transducers Between Microbial Glycoside Hydrolases and Plant Peroxidases
Authors: Scortica Anna , Giovannoni Moira , Scafati Valentina , Angelucci Francesco , Cervone Felice , De Lorenzo Giulia , Benedetti Manuel , Mattei Benedetta
Published: June 2022

Oligogalacturonide (OG)-oxidase 1 (OGOX1) and cellodextrin (CD)-oxidase (CELLOX) are plant berberine bridge enzyme-like oligosaccharide oxidases that oxidize OGs and CDs, cell-wall fragments with the nature of damage-associated molecular patterns. The oxidation of OGs and CDs attenuates their elicitor activity and concomitantly releases H2O2. By using a multiple enzyme–based assay, we demonstrate that the H2O2 generated downstream of the combined action between a fungal polygalacturonase and OGOX1 or an endoglucanase and CELLOX can be directed by plant peroxidases (PODs) either towards a reaction possibly involved in plant defense, such as the oxidation of monolignol or a reaction possibly involved in a developmental event, such as the oxidation of auxin (indole-3-acetic acid), pointing to OGOX1 and CELLOX as enzymatic transducers between microbial glycoside hydrolases and plant PODs.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Dissecting the relationship between plasma and tissue metabolome in a cohort of women with obesity: Analysis of subcutaneous and visceral adipose, muscle, and liver
Authors: Wu Zhanxuan E. , Kruger Marlena C. , Cooper Garth J. S. , Sequeira Ivana R. , McGill Anne‐Thea , Poppitt Sally D. , Fraser Karl
Published: June 2022

Untargeted metabolomics of blood samples has become widely applied to study metabolic alterations underpinning disease and to identify biomarkers. However, understanding the relevance of a blood metabolite marker can be challenging if it is unknown whether it reflects the concentration in relevant tissues. To explore this field, metabolomic and lipidomic profiles of plasma, four sites of adipose tissues (ATs) from peripheral or central depot, two sites of muscle tissue, and liver tissue from a group of nondiabetic women with obesity who were scheduled to undergo bariatric surgery (n = 21) or other upper GI surgery (n = 5), were measured by liquid chromatography coupled with mass spectrometry. Relationships between plasma and tissue profiles were examined using Pearson correlation analysis subject to Benjamini–Hochberg correction. Plasma metabolites and lipids showed the highest number of significantly positive correlations with their corresponding concentrations in liver tissue, including lipid species of ceramide, mono‐ and di‐hexosylceramide, sphingomyelin, phosphatidylcholine (PC), phosphatidylethanolamine (PE), lysophosphatidylethanolamine, dimethyl phosphatidylethanolamine, ether‐linked PC, ether‐linked PE, free fatty acid, cholesteryl ester, diacylglycerol and triacylglycerol, and polar metabolites linked to several metabolic functions and gut microbial metabolism. Plasma also showed significantly positive correlations with muscle for several phospholipid species and polar metabolites linked to metabolic functions and gut microbial metabolism, and with AT for several triacylglycerol species. In conclusion, plasma metabolomic and lipidomic profiles were reflective more of the liver profile than any of the muscle or AT sites examined in the present study. Our findings highlighted the importance of taking into consideration the metabolomic relationship of various tissues with plasma when postulating plasma metabolites marker to underlying mechanisms occurring in a specific tissue.
Transient early life growth hormone exposure permanently alters brain, muscle, liver, macrophage, and adipocyte status in long‐lived Ames dwarf mice
Authors: Li Xinna , McPherson Madaline , Hager Mary , Fang Yimin , Bartke Andrzej , Miller Richard A.
Published: June 2022

The exceptional longevity of Ames dwarf (DF) mice can be abrogated by a brief course of growth hormone (GH) injections started at 2 weeks of age. This transient GH exposure also prevents the increase in cellular stress resistance and decline in hypothalamic inflammation characteristic of DF mice. Here, we show that transient early‐life GH treatment leads to permanent alteration of pertinent changes in adipocytes, fat‐associated macrophages, liver, muscle, and brain that are seen in DF mice. Ames DF mice, like Snell dwarf and GHRKO mice, show elevation of glycosylphosphatidylinositol specific phospholipase D1 in liver, neurogenesis in brain as indicated by BDNF and DCX proteins, muscle production of fibronectin type III domain‐containing protein 5 (a precursor of irisin), uncoupling protein 1 as an index of thermogenic capacity in brown and white fat, and increase in fat‐associated anti‐inflammatory macrophages. In each case, transient exposure to GH early in life reverts the DF mice to the levels of each protein seen in littermate control animals, in animals evaluated at 15–18 months of age. Thus, many of the traits seen in long‐lived mutant mice, pertinent to age‐related changes in inflammation, neurogenesis, and metabolic control, are permanently set by early‐life GH levels.
A Novel Damage-Control Abdomino-Pelvic Packing Simulation for Obstetrician–Gynecologist Trainees [A338]
Authors: Brown Kathryn , Kaiser Jennifer E. , Einerson Brett
Published: June 2022

INTRODUCTION:

Diffuse, uncontrolled hemorrhage following postpartum hysterectomy is an uncommon situation, but one that obstetrician–gynecologists (ob-gyn) should be equipped to handle. Simulation is effective at increasing participant skill and confidence at procedures that are rarely encountered yet require practice to complete well. We devised a model to simulate "damage-control" abdomino-pelvic packing for diffuse hemorrhage after postpartum hysterectomy.

METHODS:

We created a low-fidelity, low-cost simulation for abdomio-pelvic packing using a clear plastic shower curtain, painters' towels, plastic tubing, three-quarter inch elastic, contact paper, and a vaginal delivery pelvic model. A short lecture explaining the rationale and process of abdomino-pelvic packing was given, followed by hands-on simulation of damage-control packing. Residents rotated through the simulation in pairs and performed the packing under supervision of a faculty expert. Six weeks following the simulation, a short survey was emailed to all participants to evaluate pre- and post-simulation task confidence and educational value of the model. We analyzed the results using comparative statistics.

RESULTS:

Of 19 residents participating in the simulation, 12 (63%) completed the survey. Average resident confidence performing abdomino-pelvic packing prior to the simulation was 1.7 on a 5-point Likert scale, with 5 being very confident, compared to 3.9 after the simulation (P<.001). Most respondents (58%) were able to list all supplies necessary for packing without prompting. One hundred percent of respondents “strongly agreed” the simulation was a valuable learning experience.

CONCLUSION:

We created a highly effective low-cost simulation of abdomino-pelvic packing for hemorrhage following postpartum hysterectomy that significantly increased resident confidence and knowledge in performing the procedure.
Maternal Superobesity and Visualization of Fetal Anatomy [A344]
Authors: McElwee Eliza R. , Peneva Ralitza , Dunn Faith , Singleton Aleah , Ryan Kelly M. , Head Barbara
Published: June 2022

INTRODUCTION:

Obesity rates continue to increase in reproductive age women. It is well described that obesity impairs adequate image acquisition on sonographic fetal anatomic survey. However, there are limited data regarding rates of anatomic survey completion in women with superobesity (BMI≥50). We sought to investigate adequacy of fetal anatomic visualization in women with superobesity.

METHODS:

Retrospective chart review of women with singleton nonanomalous pregnancies presenting for fetal anatomic survey from 18 0/7 to 21 6/7 weeks’ gestation between January 1, 2019 and December 30, 2020. The primary outcome was rate of total anatomic survey completion stratified by BMI category. Secondary outcomes were scan duration, number of images, and complete visualization of grouped organ systems. Results were analyzed using Chi-square and Kruskal Wallis tests where appropriate.

RESULTS:

Of 2,719 ultrasounds, 9% of patients were normal weight, 31% overweight, 55% obese, and 5% superobese. Rates of anatomic survey completion were highest in normal-weight women, and lowest in women with superobesity (67.6% vs. 4.4%, P<.001). When grouped by organ system, superobesity impacted all organ system completion rates, with cardiac structures the most affected (75% vs. 8%, P<.001). The median exam duration and number of images decreased with increasing BMI category (range 33.5-28.4 minutes and 86-63 images, respectively).

CONCLUSION:

Women with weight classifying as superobese had extremely low rates of completed anatomic survey on first attempt. Examination duration and number of images were lower for superobese patients, which may represent sonographer assessment of futility. This has important implications for anomaly detection and resource utilization.
Bladder HOTline: The Impact of COVID-19 and Telemedicine on Empiric Urinary Tract Infection Treatment in Women [A345]
Authors: Epsten Madeline J. , Ferraro Jennifer , Khan Fareesa , Brincat Cynthia , Jacobs Kristin
Published: June 2022

INTRODUCTION:

Urinary tract infection (UTI) is responsible for 15% of all community-prescribed antibiotics. The effects of the pandemic on UTI treatment are largely unknown. We evaluated the impact of COVID-19 and telemedicine on empiric UTI treatment in women, hypothesizing that increased telemedicine during the pandemic would increase empiric UTI treatment.

METHODS:

This is a retrospective cohort study of treatment patterns of female patients aged 18-65 using ICD-10 codes for acute cystitis with and without hematuria during the first 6 months of the pandemic versus the preceding 6 months. Our primary outcome was empiric antibiotic treatment, defined by treatment based on clinical picture with/without pending urine testing. To reach 80% power, we included 222 patients.

RESULTS:

The average age of participants was 42. Fifty-two percent were White, 23% Black, and 23% Hispanic. No demographic differences existed between cohorts. During the pandemic, 36.6% of UTI encounters were conducted via telemedicine, compared to 1.5% pre-pandemic (P<.0001). The rate of empiric treatment increased from 58.2% pre-pandemic to 70.5% pandemic (P=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic (P<.0001). Nitrofurantoin or trimethoprim/sulfamethoxazole was used in 79% of patients prescribed an antibiotic. The treatment adjustment rate was 17.1%.

CONCLUSION:

COVID-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment approached significance and confirmatory urine testing was done significantly less during the pandemic. Given the importance of antibiotic stewardship, it is important to further characterize telemedicine’s impact on treatment of this common condition.
Pregnant Women's Opinions on the COVID-19 Vaccination in Pregnancy [A301]
Authors: DesJardin Marcia , Raff Edward , Baranco Nicholas , Mastrogiannis Dimitrios
Published: June 2022

INTRODUCTION:

Pregnant women are at increased risk of severe disease with COVID-19. Despite strong recommendations from ACOG and the Society for Maternal-Fetal Medicine for vaccination, COVID-19 vaccination hesitancy persists. With this study, we aim to evaluate opinions about the COVID-19 vaccine in a cohort of high-risk pregnant patients.

METHODS:

Institutional review board approval was obtained. Patients attending a regional Maternal-Fetal Medicine clinic were surveyed about the COVID-19 vaccine using a standardized questionnaire. Demographic, obstetrical, and medical information were abstracted using medical records. The vaccinated and unvaccinated groups were evaluated using student t-tests and a hierarchical Bayesian logistic regression.

RESULTS:

Among the 157 participants, 38.2% received the vaccine. There were no significant differences between the groups in age, BMI, employment, race and ethnicity, gestational age, or gravity. There was no correlation with influenza or Tdap vaccination rates, nor tobacco or alcohol use. Education level was negatively correlated with vaccination status and had the largest effect size. Those with education at or less than eighth grade level were least likely to be vaccinated (95% CI, −4.46 to −0.41). Those with children in the home were less likely to be vaccinated (95% CI, −1.36 to −0.59). Unvaccinated patients chose lack of data in pregnancy (66%) as their primary concern. Most patients prefer to learn about vaccines via conversation with their doctor (46.7% for vaccinated and 59.8% for unvaccinated).

CONCLUSION:

The vaccination rate is low in our population. A provider-initiated conversation about COVID-19 vaccination included with routine prenatal care could increase the vaccination rate.
A Simulation Model of the Effects of Tailored Prenatal Care Delivery on Care Access [A308]
Authors: Zacharek Nicholas , Hocher Samuel , Kandiraju Meghana , Dawson Claire , Cohn Amy , Peahl Alex F.
Published: June 2022

INTRODUCTION:

New national prenatal care delivery guidance, the Plan for Appropriate Tailored Healthcare in Pregnancy (PATH), recommends tailoring the prenatal visit number, with 8-9 visits for low-risk patients and 12-14 visits for high-risk patients. We used simulation to explore how tailored prenatal care recommendations affect care access.

METHODS:

To evaluate the operational effects of tailored recommendations compared to usual care, a discrete event simulation was developed in C++. This model simulates dynamic patient arrivals, heterogeneous patient classifications, tailored pathways, and patient flow through the system until the end of each patient's care pathway (e.g., delivery). Patients were assigned to medically low-risk (9 visit) and high-risk (12 visit) groups based on the presence or absence of any medical conditions. Metrics captured included patient delays, overbooked appointments, and utilization. Simulation parameters were derived from a 1-year–long historical data set from a single institution. The model was run for a 52-week horizon for 1,000 replications. This study of de-identified data was deemed exempt by the institutional review board.

RESULTS:

The majority of patients in the parent dataset were medically high risk (3,527/4,968; 71%). Transitioning to the new prenatal care delivery model reduced mean delay to appointment per patient by 1 week. The percentage of patients overbooked was reduced from 27% to 24%. The average percent capacity utilized by each clinic decreased from 74% to 71%.

CONCLUSION:

In this dataset with many high-risk patients, tailoring prenatal care to medical risk factors modestly improved access parameters. Tailoring prenatal care is operationally feasible and may facilitate more equitable distribution of services.
Robotic Surgery for Endometrial Cancer Increases Intraocular Pressure: A Pilot Study [A314]
Authors: Cardenas Joel , Algarra Nelson N. , Shoraka Massoud , Mehta Sonia , Rodriguez Daniel
Published: June 2022

INTRODUCTION:

To evaluate changes in intraocular pressure (IOP) during robotic surgery for endometrial cancer.

METHODS:

A prospective study in which IOP was measured in the left and right eyes before surgery (PACU), before induction head of bed 30°, after induction 0°, after pneumoperitoneum at 14-mm Hg at 0°, after robot docking at 30° Trendelenburg, after undocking at 30°, and on supine position before extubation. IOP for each patient was averaged between the left and right eyes. Wilcoxon signed-rank tests were performed to evaluate whether IOP changed significantly between baseline (PACU) and the other time points.

RESULTS:

A total of 15 patients were included. The average IOP before surgery was 15.4±5.45 mm Hg (mean±standard deviation). The intraocular pressure increased significantly after docking the robot (average IOP increase of 9.43 mm Hg; P=.001091), after undocking (average IOP increase of 11.5 mm Hg; P=.0001; Age was 64.27 years old; BMI 38.98 Kg/m2. Tumor grade 1 (60%). Stage IA 67%. Operative time 149.53 minutes. EBL 68.3 mL. There were no intraoperative complications or readmission.

CONCLUSION:

The intraocular pressure significantly increased during robotic surgery. Caution should be exercised during surgery on patients with glaucoma or increased intracranial pressure as baseline.
Human Papillomavirus Knowledge, Vaccine Uptake, and Educational Interventions in Health Professions Students: A Systematic Review [A315]
Authors: Levy Morgan S. , Finch Lindsey , Lindsay Kara A. , Jeudin Patricia , Huang Marilyn
Published: June 2022

INTRODUCTION:

Strong recommendation of human papillomavirus (HPV) vaccination by healthcare providers increases vaccine uptake, but gaps in knowledge persist among health professional students (HPS) in professions including medicine, dentistry, dental hygiene, nursing, pharmacy, and physician assistants. Ensuring proper education of HPS as the next generation of providers can increase vaccine uptake. The purpose of this systematic review was to evaluate HPV vaccination uptake, knowledge, comfort with counseling, and educational interventions to increase knowledge in HPS.

METHODS:

A systematic literature search for articles on HPV vaccine uptake, knowledge, counseling, and educational interventions in HPS was performed in PubMed, Embase, Web of Science, CINAHL, and Scopus from January 1, 2006–July 21, 2021. Studies were screened for inclusion by two independent reviewers (disagreements were resolved by a third reviewer) and evaluated for risk of bias. PRISMA guidelines for reporting were followed.

RESULTS:

The initial search contained 6,684 articles, and 5,206 duplicates were removed. A total of 1,459 studies were screened by title and abstract, and 1,372 studies did not meet inclusion criteria. Eighty three articles underwent full-text review. A total of 23 studies were included in analysis. Gaps in knowledge surrounding HPV vaccination and low rates of vaccine uptake were consistent across professions. Educational interventions were effective in increasing knowledge levels and comfort with counseling.

CONCLUSION:

This systematic review identified low rates of HPV vaccination amongst HPS, gaps in knowledge, and discomfort with counseling on HPV vaccination. Education on HPV vaccination must be provided in all health professional programs of potential vaccine providers to increase vaccine uptake and prevent cancer.
Focal-Occult Placenta Accreta Spectrum: A Clandestine Source of Maternal Morbidity [A268]
Authors: Larish Alyssa , Norgan Andrew , Schenone Mauro , Branda Megan , Horst Kelly , Theiler Regan
Published: June 2022

INTRODUCTION:

While focal-occult placenta accreta spectrum (PAS) is known to lead to adverse outcomes, little is known of the morbidity in comparison to previa-associated PAS.

METHODS:

After IRB approval, retrospective review was conducted of pathologically confirmed (decidual layer absence or basal-plate myometrial fibers) PAS from 2018 to 2021 at a tertiary care center. Baseline characteristics and surgical, obstetric, and subsequent pregnancy outcomes were recorded. Focal-occult PAS was compared with previa-associated PAS using Kruskal-Wallis/Chi-square tests; P<.05 was considered significant.

RESULTS:

A total of 56 cases were identified: 22 previa-associated and 34 focal-occult PAS. All patients with previa-associated and 26.5% of those with focal-occult PAS underwent hysterectomy. Of the previa-associated PAS patients, 20 of 22 were diagnosed antenatally, as was 1 of 34 focal-occult PAS patients. Mean maternal age (32.5 vs. 33.1 year), number of previous dilation and curettage procedures (0.4 vs. 0.3), and in vitro fertilization rates (4.5% vs. 23.5%) were not significantly different between groups. Mean parity (3.7 vs. 1.4), gestational age at delivery (34.3 vs. 35.7 weeks), any previous cesarean delivery (95.5% vs. 29.4%), mean number of previous cesareans (2.5 vs. 0.5), and placental locations were significantly different between groups. All measures of morbidity, including postpartum hemorrhage rates (81.0% vs. 75.8%), median qualitative blood loss (1,500cc, range: 500–9,516cc vs. 1,660cc, range: 350–12,220cc), mean units of red blood cells transfused (1.8 vs. 1.9), massive transfusion (9.1% vs. 20.6%), ICU admission (9.1% vs. 14.7%), and reoperation rates (9.1% vs. 32.4%) were similar between groups. Six focal-occult PAS patients had a subsequent pregnancy, and two had recurrent PAS.

CONCLUSION:

Despite representing lower grade PAS, focal-occult PAS has similar measures of morbidity when compared to previa-associated PAS, potentially attributable to lack of antenatal detection.
Gestational Weight Gain in Patients With Obesity and Diabetes: A Comparison of 2009 Institute of Medicine Versus 2019 JAMA Recommendations [A270]
Authors: Han Joan , Ohaegbulam Gail , Yan Fengxia , Lindsay Michael , Geary Franklyn H. , Lee Regina
Published: June 2022

INTRODUCTION:

Excessive gestational weight gain (GWG) is associated with adverse maternal and neonatal outcomes. Current guidelines established by the United States' Institute of Medicine (IOM) in 2009 recommend GWG of 11–20 lb for all obese patients. In 2019, a JAMA meta-analysis proposed recommending less weight gain in obesity (0–13 lb), not accounting for pre-existing maternal co-morbidities. We aim to ascertain whether, in obese diabetic pregnancies, GWG within the updated JAMA guidelines is associated with better outcomes.

METHODS:

IRB approval was obtained. Using a large urban hospital's de-identified obstetric database, obese diabetic patients from 2011 to 2020 were categorized into two groups: IOM and JAMA, depending on their GWG. Diagnosis codes were used to assess outcomes. Chi-square test, independent samples T-test, and Wilcoxon rank-sum test were used.

RESULTS:

Of 240 patients with obesity and diabetes, 135 fell within IOM weight gain guidelines and 65 within JAMA. The groups were not significantly different in age, BMI, A1C, or proportion with prior cesarean delivery. For maternal outcomes, chronic hypertension was independently associated with weight gain within the JAMA guidelines versus IOM (55% vs. 36%, P=.0082). There were no significant differences in rates of cesarean delivery (P=.73) or pre-eclampsia (P=.92). For neonatal outcomes, no differences were noted in NICU admission (P=.73), macrosomia (P=.72), or preterm delivery (P=.21) rates.

CONCLUSION:

For women with obesity and diabetes, chronic hypertension was associated with marginally less weight gain. Further research may be needed before clinicians advise the stricter GWG recommendations in the new JAMA guidelines rather than the current standard of IOM guidelines.
A Quality-Improvement Project to Improve Diagnosis and Management of Chorioamnionitis on Labor and Delivery [A274]
Authors: Neuhoff Barbara K. , Wells Joshua , Tufton Anne , Heath Maya , Olister Staci , Holman Stacey L.
Published: June 2022

INTRODUCTION:

Chorioamnionitis is an intraamniotic infection and inflammation that is associated with significant neonatal and maternal morbidity. However, diagnostic criteria can vary greatly among providers, leading to unnecessary antibiotic administration and interventions in the mother and neonate. An interdisciplinary quality-improvement team sought to standardize diagnostic criteria for chorioamnionitis on labor and delivery. Previous analysis identified that 60% of chorioamnionitis diagnoses at our institution did not meet ACOG diagnostic guidelines.

METHODS:

The following interventions were implemented: 1) dissemination of data regarding over-diagnosis and treatment, 2) department-wide educational sessions, and 3) publication of diagnostic guidelines at work stations and on a hospital shared drive. After IRB approval, a before-and-after retrospective cohort study was carried out from 4/1/2018 to 9/30/2021 (intervention: 11/2019) to determine the interventions' impact on compliance with recommended ACOG-supported diagnosis and management of chorioamnionitis. Relevant morbidity rates for patients and neonates with an ICD-9/10 code related to peripartum infections were also analyzed.

RESULTS:

Patients received the diagnosis of chorioamnionitis significantly less frequently after interventions (pre: 145 of 4,515, 3.21% of deliveries; post: 101 of 5,085, 1.99% of deliveries, P<.0002). The incidence of charted diagnoses that did not meet ACOG criteria significantly decreased after interventions (55.86–28.71%, P<.0001). The differences in maternal endometritis as well as maternal and neonatal sepsis were not statistically significant in the pre- and post-intervention groups (P<.0501, P<.1548, P<.0933).

CONCLUSION:

Guideline-based diagnosis of chorioamnionitis can be successfully implemented on labor and delivery, leading to less antibiotic use and fewer maternal and neonatal interventions. Implementation was also completed without an increase in maternal or neonatal morbidity.
Length of Maternity Leave and Breastfeeding Outcomes Among Physicians [A284]
Authors: Awomolo Adeola , Louis-Jacques Adetola , Eischen Emily , Jones Laurie , Braden Andrea L. , Crowe Susan
Published: June 2022

INTRODUCTION:

Physicians face unique challenges in the postpartum period, including limited maternity leave. We aim to determine the relationship between length of maternity leave and breastfeeding outcomes.

METHODS:

Physicians who had a singleton pregnancy during the most strenuous time of their career were included in the cross-sectional survey. Questions were adapted from the CDC's Infant Feeding Practices Study and Pregnancy Risk Assessment Monitoring System, along with investigator-developed questions. Surveys were distributed through social-media physician groups and email listservs. Descriptive and bivariate analyses were completed via STATA version 17.

RESULTS:

Of the 807 responses, 637 were eligible and complete. The most strenuous time identified was during residency (36%). Greater than 30 specialties and subspecialties were represented, and the most common were pediatrics (37%), obstetrics and gynecology (18%), and family medicine (16%). There were associations between medical specialty (P=.006) and birth year (P<.0001) and length of maternity leave. The average maternity leave duration was 10±0.4 weeks. Maternity leave >6 weeks was associated with meeting personal breastfeeding goals compared to ≤6 weeks (80% vs 71%, P=.02). The mean duration of breastfeeding for respondents with ≤6 weeks maternity leave was 15±1.7 months while the mean duration for those with >6 weeks was 17±1.4 months (P=.01). There was a positive correlation between breastfeeding duration and maternity leave (R
2=0.12, P=.01).

CONCLUSION:

There is a relationship between length of maternity leave and breastfeeding outcomes. Supporting adequate maternity leave for physicians, especially those in training, is important for breastfeeding outcomes.
Pelvic Pain Disorders and Associated Acceptability of Office Hysteroscopy [A288]
Authors: Brant Amanda C. , Echetebu Nneanata , Mara Kristin , Laughlin-Tommaso Shannon , Hopkins M. , Green Isabel
Published: June 2022

INTRODUCTION:

Despite the benefits, convenience, and acceptability of office hysteroscopy (OH), 20% of patients find OH unacceptable. In this study we defined acceptability as willingness to undergo office hysteroscopy in the future and investigated whether patients with co-existing pelvic pain disorders were more likely to find OH unacceptable.

METHODS:

Patients who underwent OH from 12/2016 to 6/2018 were included. Patients were asked to rate acceptability at the time of their procedure. Retrospective chart review was used to identify patients with pelvic pain disorders defined as chronic pelvic pain (CPP), dysmenorrhea, vulvodynia, dyspareunia, or high tone pelvic floor dysfunction (PFD). Patients rating OH as acceptable (Likert scale 4–5) were compared to those rating it as unacceptable (Likert scale 1–2). Comparisons between groups were made using a t-test or Wilcoxon rank sum test for continuous data, and a Chi-square test for categorical data. This study was determined to be exempt from the requirement for IRB approval (IRB #20–009387).

RESULTS:

Compared to patients in the “acceptable” group (n=929), patients who rated OH as “unacceptable” (n=55) reported higher during and post-procedure pain scores and lower satisfaction rates (P<.001). Prior diagnosis of PFD (P<.001) and dyspareunia (P=.003) were both associated with finding OH unacceptable. Dysmenorrhea, CPP, and vulvodynia were associated with unacceptability but did not achieve significance.

CONCLUSION:

A preexisting diagnosis of a pelvic pain disorder, specifically PFD and dyspareunia, was associated with unacceptability of OH. Implementing triage criteria for patients to pursue hysteroscopy with sedation or anesthesia could help improve patient satisfaction and warrants additional study.
Prenatal Visit Vitals: Comparison Between Virtual And Traditional Visits [A294]
Authors: DeWitt Jason
Published: June 2022

INTRODUCTION:

Prenatal visits via a virtual platform are increasingly offered to patients. Previous studies have shown favorable acceptance by patients. The COVID-19 pandemic dramatically accelerated adoption of this new technology. This study was designed to compare documentation of maternal blood pressure and weight between virtual visits and traditional face-to-face visits.

METHODS:

The study is a retrospective comparison of documentation of blood pressure and maternal weight between virtual and traditional face-to-face prenatal visits between January 2019 and June 2021. IRB exemption was obtained. The electronic medical record of a large midwest U.S. health system was utilized to identify prenatal visit encounters for all patients at all gestations. The visits were grouped into virtual visits and face-to-face visits. Data analytics were used to compare documentation of maternal weight, systolic blood pressure, and diastolic blood pressure for both subgroups. Data were further broken down by month to show comparison over time. Comparison was also made by gestational age.

RESULTS:

A total of 108,428 prenatal visits were identified. Of these, 7,004 (6.5%) were virtual visits. Appropriate documentation of blood pressure was absent in 3% of face-to-face visits and 46% of virtual visits. For the maternal weight, data were missing for 3% of face-to-face visits and 66% of virtual visits.

CONCLUSION:

Studies validating the safety of virtual prenatal visits are lacking. This analysis identifies obstacles that need to be overcome to improve the safety of virtual care.
Single-Dose Oral Secnidazole for Treatment of Trichomoniasis in Women With BV Co-infection [A119]
Authors: Muzny Christina A. , Kaufman Gregory , Sematczyn Anna , Pandey Brajesh , Chavoustie Steven E.
Published: June 2022

INTRODUCTION:

Bacterial vaginosis (BV) and trichomoniasis are the most common causes of vaginitis. Both infections are associated with increased risk for HIV/STIs and adverse reproductive health outcomes. Coexistence of BV pathogens and Trichomoniasis vaginalis is common, with co-infection rates of 60–80%. In this secondary analysis of clinical trial data of single-dose oral secnidazole (SEC) for the treatment of women with trichomoniasis, we review a subset of women with both trichomoniasis and BV.

METHODS:

In an institutional review board‒approved study, women with clinically diagnosed trichomoniasis were randomized to SEC 2 g oral granules or placebo at baseline (Visit 1). At Visit 2 (days 6–12), patients were evaluated for test-of-cure by T. vaginalis culture and were provided the opposite treatment. The primary endpoint was microbiological cure (negative culture for T. vaginalis) at the TOC visit. BV was clinically diagnosed at both visits using Amsel’s criteria.

RESULTS:

Overall, 147 women were enrolled; the modified intent-to-treat (mITT) population included 131 randomized patients. Cure rates were 92.2% and 1.5% for SEC and placebo (P<.001). The per-protocol population included 119 patients. Cure rates were 94.9% and 1.7% for SEC and placebo, respectively. In the mITT subgroup of women with BV based on at least three Amsel criteria (n=79), cure rates for trichomoniasis were 97.67% (42/43) for SEC and 0/36 for placebo.

CONCLUSION:

Single-dose oral SEC was highly effective in treating trichomoniasis in women with BV co-infection. Co-infection is common and appropriate treatment for both infections is critical. SEC is the only FDA-approved single-dose treatment for BV in women and trichomoniasis in women and men.
Oral Ibrexafungerp Outcomes in Subjects With Refractory Vulvovaginal Candidiasis From an Open-Label Study (FURI) [A122]
Authors: Goje Oluwatosin , King Thomas , Angulo David , Azie Nkechi
Published: June 2022

INTRODUCTION:

Ibrexafungerp, a novel one-day oral triterpenoid antifungal, was recently approved for the treatment of vulvovaginal candidiasis (VVC). Ibrexafungerp is a fungicidal with broad activity against Candida species, including fluconazole-resistant strains. We present data from an open-label Phase 3 study (FURI), which enrolled patients with refractory VVC utilizing a 3-day dose ibrexafungerp regimen.

METHODS:

FURI VVC subjects were included if they had proven or probable severe VVC, with evidence of treatment failure, intolerance, or toxicity to a currently approved standard-of-care antifungal treatment. Subjects with VVC received ibrexafungerp monotherapy given as oral doses of 375 mg twice daily every three days for a total of three dosing days (Day 1, Day 4, and Day 7). Global Response or Clinical Improvement, defined as complete or partial resolution of signs and symptoms with total vaginal signs and symptoms composite score<1, without need for additional antifungal, was measured at Day 17.

RESULTS:

There were 14 VVC patients enrolled in FURI from 2019 to 2021. All patients had previously failed other therapies, including fluconazole, and were referred to an infectious disease specialist at a tertiary-care setting. Global response measured at Day 17 indicated that 12 patients (85.7%) had clinical improvement, one patient had partial improvement and one patient was deemed indeterminate. Adverse events for ibrexafungerp were predominantly gastrointestinal, with mild-to-moderate diarrhea, nausea, and abdominal pain.

CONCLUSION:

These results demonstrate the therapeutic potential of a 3-day dose of oral ibrexafungerp for the treatment of patients with VVC who have failed other treatments.
Effects of the COVID-19 Pandemic on Tdap (Tetanus, Diphtheria, Pertussis) Vaccination During Prenatal Care [A123]
Authors: Smith Alicia , Paoletti Andrew , Jaspan David , Goldberg Jay
Published: June 2022

INTRODUCTION:

It is recommended to administer the tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine during pregnancy. We evaluated whether the COVID-19 pandemic affected Tdap vaccination during periods when (1) many prenatal visits were via telemedicine and (2) patients might be vaccine wary due to COVID-19 vaccination misinformation.

METHODS:

This was a retrospective observational study using data queried from the Einstein Healthcare Network electronic medical record. The study included patients who delivered between 2019 and 2021 and their Tdap vaccination status during prenatal care. Chi-square tests compared vaccination rates between patients delivering at different times.

RESULTS:

Of the pre-pandemic pregnancy control group (n=1,408), 60% received Tdap vaccination. In the second quarter of 2020, when many prenatal visits were done via telemedicine, patients (n=688) were 1.3 times more likely to not receive Tdap vaccination (54%; P=.0033). During the second quarter of 2021, when there was much misinformation regarding COVID-19 vaccination, even with all prenatal visits being in person, patients (n=363) were 1.3 times more likely to not have received the Tdap vaccination (54%; P=.028). True percentages of Tdap vaccination were higher than those reported above due to 16% of patients who received either prenatal care elsewhere or no prenatal care, for whom no vaccination data was available.

CONCLUSION:

Compared to pre-COVID-19 pandemic, pregnant patients were less likely (OR, 1.3) to have consented to and received the Tdap vaccination during periods when (1) many prenatal visits were via telemedicine and (2) patients might be vaccine wary due to COVID-19 vaccination misinformation.