bluuebunny/crossref_metadata_2025 huggingface dataset:
Neonatal Outcomes in Single Agent vs. Combination Therapy in Management of Maternal Diabetes in Pregnancy [26A]
Authors: Scrivani Claire , Cortez Briana , Chisholm Christian , Boyle Annelee C. , Ferguson James E. , Dudley Donald J.
Published: May 2019

INTRODUCTION:

To determine if there are decreased rates of neonatal hypoglycemia when type 2 diabetes mellitus (T2DM) is treated with combined insulin and oral hypoglycemic agent compared to insulin, oral hypoglycemic agent, or diet alone.

METHODS:

We performed an IRB approved, retrospective chart review of 357 women with a diagnosis of T2DM who delivered at our center from 1/2012 to 12/2017. Patients were managed by with diet alone, insulin alone, oral hypoglycemic agent alone, or combined insulin and oral hypoglycemic agent. Primary outcome was neonatal hypoglycemia, defined by the pediatric care providers in discharge diagnoses. Secondary outcomes included birth weight, NICU admission, neonatal death and composite neonatal outcome score (CNOS) that included respiratory failure, respiratory distress syndrome (RDS), death at delivery, ventilator use, admission to NICU, shoulder dystocia, and perinatal death.

RESULTS:

Of the 357 women included in the study, 11% who were treated with diet alone, 8.2% who were treated with insulin alone, 9.6% who were treated with oral agent alone and 8.7% who were treated with both insulin and oral agent delivered infants that were diagnosed with neonatal hypoglycemia (P=.90). Neonatal death was observed in 3.6% (4/112) of women treated with diet alone, whereas no neonatal death was observed in the other treatment groups (P=.04). There was no significant relationship between treatment type and the CNOS.

CONCLUSION:

Maternal use of combined insulin and oral hypoglycemic agent for T2DM in pregnancy did not improve, or worsen, neonatal hypoglycemia and other neonatal outcomes. However, neonatal death was more common in diet controlled diabetes.
Group Prenatal Care: A Promising Quality Measure in Ambulatory Obstetrics [28A]
Authors: Meadows Audra Roberston , Barrett Francesca , Manigat Charlee , Murphy Jennifer , Blanchfield Bonnie
Published: May 2019

INTRODUCTION:

The group prenatal care (GPC) practice model has demonstrated success in achieving quality goals such as improved outcomes, care satisfaction and reduced costs. We sought to improve care quality among women receiving prenatal care in an urban, obstetrical residency training practice by implementing a GPC option.

METHODS:

We conducted a retrospective study comparing women in a GPC pilot cohort to a risk-based, matched cohort of women receiving individual prenatal care in the same practice from 2015 to 2018. Maternal and newborn outcomes and cost were assessed. Descriptive analysis was used to characterize the cohorts and bivariate analysis was used to compare outcomes and costs. Date were obtained from electronic medical records and hospital financial systems.

RESULTS:

Rates of cesarean delivery (17.9% vs 33%, p = 0.04) and neonatal intensive care unit (NICU) admissions (1.8% vs 17%, p = <0.01) were decreased among women in the GPC cohort compared to those in individual care. Reduced NICU admissions saved the Medicaid program approximately $256,216 or $37,027 per avoided admission.

CONCLUSION:

Few ambulatory quality metrics are defined in obstetrical care. GPC implemented in an urban, residency training practice setting improved outcomes and reduced costs compared to those in individual prenatal care. GPC is a promising model to improve quality among ambulatory obstetrics training practices.
Doing the Month: Traditional Asian Postpartum Practices at a Federally Qualified Health Center [31A]
Authors: Zheng Micha , Liu Stephanie , Kallen Michael , Nguyen Van Thuy , Kay Kerry , Ivey Susan
Published: May 2019

INTRODUCTION:

“Doing the month” (DTM) is a traditional Asian month-long postpartum practice. Although there are varying levels of adherence, in its strictest form, women are not allowed to shower, leave the house, or brush their teeth.

METHODS:

A cross-sectional survey was developed in consultation with a psychometrician to determine the estimated prevalence of women who have participated in DTM. Female patients in a federally qualified health center's waiting room were surveyed in Cantonese, Mandarin, Vietnamese, and English. This study was approved by the UC Berkeley Institutional Review Board.

RESULTS:

One hundred fifty-four respondents participated; mean age was 40.1. Without prompting, 37.7% responded that they had heard of DTM. After an explanatory paragraph, 76.6% participants reported they had heard of DTM. Out of patients that have children, 60.7% “did the month” after giving birth. Likert-type scale questions showed that respondents believed DTM was stressful but enjoyable and helpful for recovery from childbirth.

CONCLUSION/IMPLICATIONS:

The majority of immigrant Asian women at this FQHC had heard of and participated in DTM. Asian immigrants are projected to become the largest foreign-born group in the U.S. by 2055. DTM is a common practice that providers should be aware of in order to promote postnatal health of both infant and mother. Drinking rice wine, recommended in DTM practices, could affect developing infants and may need to be addressed in breastfeeding patients. Being unable to shower or leave the house for a month may contribute to postpartum infections or depression. Obstetric residencies should include curriculum regarding this practice.
Evaluating the Quality and Reliability of Online Information on Social Fertility Preservation [38A]
Authors: Shao Yi-Hong , Spence Andrea , Tulandi Togas , Abenhaim Haim Arie
Published: May 2019

INTRODUCTION:

Rising trends to postpone motherhood, has coincided with increasing infertility rates. Social fertility preservation offers the potential to overcome this age-related infertility and many women are turning to the Internet to seek medical information. The aim of our study was to evaluate online information on social fertility preservation.

METHODS:

We used five search terms, “egg freezing,” “fertility preservation,” “social egg freezing,” “social fertility preservation” and “oocyte cryopreservation,” to identify the most popular sites rated by Google. The information and quality were rated based on four categories: Silberg's accountability criteria, Abbott's aesthetic criteria, Flesch-Kincaid readability score and the Canadian Fertility and Andrology Society (CFAS) and the Society of Obstetrics and Gynecology of Canada (SOGC) guideline recommendations.

RESULTS:

We identified 21 most utilized websites. The average Silberg score was 6.57, with 85.7% of websites meeting the criteria for adequate accountability. Only one website (4.8%) did not meet the criteria for appropriate esthetic appeal. The average Flesch-Kincaid readability score was 11.39, equivalent to a Grade 11 reading level, which is significantly higher than the targeted reading level of the general population (Grade 8). 57% of websites contained less than half of the evidence-based recommendations provided in the CFAS and SOGC guideline recommendations.

CONCLUSION:

Online information on social fertility preservation is easily accessible and esthetically pleasing, but it is not easily readable and does not reflect evidence-based recommendations. In light of our findings, physicians must fill the knowledge gaps and adequately counsel their patients to optimize a woman's chance at a successful pregnancy.
Beyond Hormonal Impact: A Qualitative Analysis of the Intravaginal Ring (IVR) on Women's Sexual Experiences [1B]
Authors: Lu Connie F. , Vargas Sara E. , Guillen Melissa , Carbone Sofia , Ramirez Jaime , Guthrie Kate M.
Published: May 2019

INTRODUCTION:

Current contraceptive literature includes limited studies focusing on the impact of contraceptive methods (exclusive of condom-only contraception) on women's sexual experiences. Many of these focus on hormonal effects of oral contraceptive pills (OCPs). Though important, women's experiences with contraception extend far beyond hormonal impacts. This study aims to add depth to the knowledge base by exploring the meaningful effects of intravaginal rings (IVR) on women's sexual experiences, highlighting the IVR as a device physically experienced by both the user and her sexual partner(s).

METHODS:

Twelve women, aged 18-45 years, used the IVR for 3-6 months, and completed daily phone surveys, monthly web surveys, and in-depth interviews regarding IVR use. This thematic content analysis of qualitative data explores how the IVR affects participants' sexual experiences.

RESULTS:

Sexual experiences with the IVR elicited a range of user reactions. Women reported impacts on their sexual experiences related to physical (e.g., feeling the IVR during sex), administrative (e.g., navigating IVR removal before sex), and relationship factors (e.g., partner's sexual comfort and pleasure). Women derived both positive and negative meaning from these experiences, which then altered and individualized their use and subsequent opinions of the IVR.

CONCLUSION:

The range of IVR impacts on women's sexual experiences shape their use and opinions of the product, leading to either increased motivation or poor adherence and discontinuation. Awareness of these individualized experiences can help providers better understand and guide their patients through effective IVR use. Research on user experiences across contraceptive methods is necessary to support women's sexual and reproductive health.
Immersive Virtual Reality Intervention for Anxiety Reduction During In-Office Dilation and Curettage [4B]
Authors: Zhang Shiliang , Woodson Ryan , Sridhar Aparna
Published: May 2019

INTRODUCTION:

Progress in virtual reality (VR) has generated interest in using VR as a method for managing patient anxiety and subsequently decreasing pain. We assessed the practicality and effects of VR use among patients presenting for first-trimester surgical abortion at our academic center.

METHODS:

In this prospective pilot study, we consented women presenting for first trimester surgical abortion in office under local anesthesia. We enrolled a convenient sample of 30 participants (15 experimental and 15 control). Experimental participants were given a commercially available VR device to wear during the procedure. Anxiety scores using Modified Amsterdam Preoperative Anxiety and Information Survey (MAPAIS) and the Visual Analog Scale (VAS) were recorded before, during, and after the procedure in both groups.

RESULTS:

The two groups showed no significant differences in anxiety prior to procedure (P=0.29). On average the experimental group demonstrated lower anxiety during and after the procedure though results were not statistically significant in the pilot phase. Among participants in the experimental group, those who used the VR device for over 5 minutes (n=11) had statistically significant decrease in anxiety compared to those who used the device for a shorter period of time (n=4) (P=0.018).

CONCLUSION:

Our results suggest that VR can be used during in-office dilation and curettage and may have an impact on decreasing procedure-related anxiety. Based on our findings, we determine that a sampling size of 156 total participants would be sufficient for a target power of 0.80.
Current Residency Training: Increased Education Regarding the Care of Transgender and Gender Non-Binary Patients [8B]
Authors: Chiarappa Ashley , Francis Amanda , Zheng Julia , Bachmann Gloria A.
Published: May 2019

INTRODUCTION:

An American College of Obstetricians and Gynecologists (ACOG) committee opinion in 2011 urged health insurance plans to cover transgender and gender non-binary (TGNB) affirming care and in 2017, another one reviewed medical guidelines that obstetrician-gynecologists should apply in addressing the needs of TGNB adolescents. Given this evolving clinical landscape, a difference in education regarding TGNB specific training, education and experience levels between Ob/Gyn residents and attendings was studied.

METHODS:

A twenty-one item survey was emailed to APGO program coordinators to distribute to their program directors and residents from February to April, 2018. This anonymous survey included demographics and TGNB perceptions, education and hands-on training.

RESULTS:

Of the 150 programs contacted, an unknown number of surveys was distributed. 200 surveys were email assessed, with 164 filled out. Providers included 2 PA/NP/APN (excluded from analysis), 49 attendings and 113 residents. Of the 126 physicians who cared for TGNB patients, 51 providers (44.73%) cared for five or more TGNB patients. Fifty-eight percent of residents and 79% of attendings reported inadequate/no formal TGNB training. One attending (2%) vs 11 residents (9.7%) reported 11 or more hours of TGNB education during medical school. Proportionally more attendings vs residents felt uncomfortable performing (33.33% vs 8.65%) and had performed fewer (14.28% vs 25.66%) gender affirmation hysterectomies/oophorectomies.

CONCLUSION:

These results suggest that attendings less contemporarily trained than current residents had less TGNB specific training and clinical experience. Additional educational endeavors for the entire health care team would be a positive asset to advancing TGNC healthcare.
Access to Antenatal Care and Hospital Delivery Among Haitian Migrant Mothers Within Batey Communities of La Romana [11B]
Authors: Ford Chandler , Batson Stephanie , Zucconi Rebecca , Brownell Elizabeth
Published: May 2019

INTRODUCTION:

The batey communities in the sugarcane fields of La Romana, Dominican Republic house thousands of Haitian migrant families. Many of these bateyes lack electricity, potable water and reliable healthcare infrastructure. In 2015 the World Health Organization (WHO) reported a maternal mortality rate of 92/100,000 births in the Dominican Republic but rates within bateyes remain unspecified.

METHODS:

We evaluated barriers related to antenatal care and labor and delivery experience potentially associated with increased maternal mortality risk among Haitian migrant mothers living in bateyes. Under IRB approval qualitative interviews were conducted within 16 bateyes among 68 adult migrant mothers who experienced 1 live birth <3 years. Results were compared to the 2016 WHO recommendations.

RESULTS:

68% of women did not meet the recommended minimum of eight antenatal care contacts. 22% traveled more than two hours for a visit. Relative to WHO recommendations: 93% of women had their blood pressure taken, 88% had urine collected and 79% received at least one ultrasound during a visit. 47% did not initiate prenatal vitamin use until their second trimester. Reasons for this delay were attributed to cost and inconsistent provider access. The WHO recommends establishment of antenatal care by 10 weeks gestation, the average gestational age at first visit among batey mothers was 18 weeks. 91% gave birth in hospital, reflecting strong maternal preference attributable to perceived maternal safety.

CONCLUSION:

In accordance with WHO antenatal care recommendations, optimal care in the bateyes is not fully achieved and warrants further interventional studies assessing consistent provider contact during the first trimester.
Accuracy of Leopold's Maneuver Compared to Ultrasound in Estimating Fetal Birth Weight [12B]
Authors: Tell Noor , Omuso Inara , Hunter Krystal , Khandelwal Meena
Published: May 2019

INTRODUCTION:

Estimation of fetal birth weight is a critical data point that can affect the management of women in term labor. However, the superior method of estimating fetal birth weight (EFW) using Leopold's maneuvers versus ultrasound continues to be debated. This study aimed to compare the accuracy of clinical estimation with that of ultrasound-guided estimation. This study also evaluated the accuracy of both methods with Body Mass Index (BMI).

METHODS:

This retrospective study was IRB-approved and included singleton pregnancies between 37 and 42 weeks of gestation admitted for labor and delivery, between 2013 and 2014. Included women had ultrasound and clinical estimation of EFW using Leopold's maneuvers. The statistical tests used include McNemar and t-test.

RESULTS:

A total of 102 women were randomly selected, and 1 was excluded for missing data. The mean maternal age was 29.2 (+/-5.9); 25.5% were African American, 25.5% Hispanic, and 39.2% White. Of the 101 women, 42 women had an ultrasound completed within 14 days before birth. The accuracy of clinical EFW and ultrasound EFW within 20% of actual birth weight was 88.1% and 71.3%, respectively, overall (p=0.003); but in women in whom the ultrasound was completed 14 days prior to birth, there was no difference (p=0.45). BMI has no significant effect on the accuracy of EFW via either method.

CONCLUSION:

In our sample, there is no significant difference in accuracy of clinical and ultrasound EFW. Obstetricians should continue to teach and practice Leopold's maneuver because of its practicality, availability, and lack of cost compared to ultrasound-guided estimation.
Association of Proinflammatory and Proinsulinemic Food Groups With Maternal Postpartum Weight Retention [18B]
Authors: Mahabamunuge Jasmin , Simione Meg , Horan Chrissy , Redline Susan , Davison Kirsten , Taveras Elsie
Published: May 2019

INTRODUCTION:

Few studies have examined associations of maternal intake of proinflammatory and proinsulinemic food types with substantial postpartum weight retention (SPPWR; ≥5 kg) at 6 months.

METHODS:

We studied 308 mother-infant pairs enrolled in the Rise and SHINE study, a longitudinal birth cohort. Maternal diet, including consumption of foods with proinflammatory and proinsulinemic properties such as sugar-sweetened beverages (SSBs), red/processed meats, sweet snacks and fast food, and fruit/vegetables, was assessed in the third trimester and at 1-month postpartum via the NHANES Dietary Screener Questionnaire. Postpartum weight retention was calculated as the difference between pregravid and 6-month postpartum weight.

RESULTS:

At 6-months, 29.6% of the mothers had SPPWR. In multivariable analyses adjusted for race/ethnicity, income, maternal age, pre-pregnancy BMI and gestational weight gain, we found that each additional serving/day of SSBs was associated with higher odds of SSPWR (OR: 1.43; 95% CI: 1.11, 1.85). Intake of red/processed meats (OR: 1.97; 95% CI: 0.55, 7.13) in the third trimester, and SSBs (OR: 1.27; 95% CI: 0.94, 1.72), red/processed meats (OR: 1.96; 95% CI: 0.83, 1.12) and fast food (OR: 1.35; 95% CI: 0.17, 10.79) at 1-month postpartum were also associated with higher odds of SPPWR but confidence intervals were wide and spanned 1.0.

CONCLUSION:

Our results show that consumption of SSBs, and possibly other proinflammatory and proinsulinemic foods in the third trimester and 1-month postpartum is associated with SPPWR. Avoiding such beverages and foods during this window may reduce SPPWR and the risk for long term weight retention.
Definition and Incidence of Severe Surgical Site Infections After Cesarean Delivery [24B]
Authors: Ross Naima , Messina Maria , Robinson Letrease , Saiman Lisa , Goffman Dena , Duffy Cassandra
Published: May 2019

INTRODUCTION:

Surgical site infections (SSI) are common complications following cesarean delivery. As part of a performance improvement project, we recognized the need to differentiate infections based on severity and thus sought to characterize the most severe cases of SSI.

METHODS:

We performed a retrospective review of women ≥18 years or older who delivered by cesarean in 2016 and 2017 at a Women's Hospital. Using a combination of ICD-10 diagnosis codes, the electronic medical record, and infection control surveillance, we identified cases and confirmed all diagnoses by chart review using CDC definitions for SSI. We defined severe SSI as cases requiring additional treatment (change in antibiotics or additional procedure), readmission, CT imaging, ICU admission, or length of stay ≥7 days. We compared maternal demographics and clinical characteristics between severe and non-severe cases using the Student t-test and Fischer exact test as appropriate.

RESULTS:

Among 3,507 cesarean deliveries, 141 met criteria for SSI. Of these, there were 53 cases of severe SSI. Women with severe SSI were older (31.9 vs. 30.2 years, p=0.01), had lower gestational ages at delivery (35.8 vs. 37.6 weeks, p<0.01), were more likely to have diabetes (26.4% vs. 10.2%, p=0.02) and less likely to have endometritis only (50.9% vs. 81.8%, p<0.01). There was no difference between groups in BMI, prior cesarean, hypertension, GBS status, length of labor or rupture of membranes, or emergent/urgent deliveries.

CONCLUSION:

In our cohort, severe SSI was associated with older age, diabetes, and earlier deliveries. Further research is needed to identify modifiable risk factors and guide prevention strategies.
Neonatal Outcome Differences Among Providers With Lower Nulliparous, Term, Singleton Vertex Cesarean Rates [30B]
Authors: Wong Melissa Spring , Wells Matthew , Govindappagari Shravya , Gregory Kimberly D.
Published: May 2019

INTRODUCTION:

While increasing rates of cesarean deliveries are known to be associated with worsening maternal and neonatal outcomes, it is unknown whether there are adverse effects to maternal or neonatal outcomes by significantly lowering the cesarean rate. The objective of this study was to identify whether there were differences in maternal or neonatal outcomes among providers with lower NTSV cesarean rates.

METHODS:

A retrospective cohort study of all providers performing deliveries at an academic, tertiary care, community hospital from 2011-2017. Efforts were ongoing to lower the hospital NTSV rate. Providers were analyzed individually and in groups according to whether their cumulative NTSV was greater or less than 23.9%. Outcomes of interest included rates of severe maternal morbidity (SMM) and indicators of neonatal morbidity: abnormal cord blood gases, 5-minute APGAR, and term neonatal intensive care unit (NICU) admission.

RESULTS:

46,597 deliveries were performed by 91 unique providers. NTSV cesarean rates ranged from 7.6-68.0%. There were no differences in rates of SMM, abnormal cord blood gases or 5-minute APGAR scores. Term NICU admission rates, however, did differ: providers who had NTSV cesarean rates ≤23.9% had higher NICU admission rates compared to those whose NTSV cesarean rate was >23.9% (6.55% vs 4.54%), though this was not statistically significant. Analyzed at an individual provider level, there was a statistically significant positive correlation between NTSV cesarean rates and NICU admission (p=0.006).

CONCLUSION:

Providers with lower NTSV cesarean rates were noted to have higher term NICU admission rates.
Can Our Words Hurt? Effects of Using Phrases With Unpleasant Emotional Connotation on Perceived Pain [31B]
Authors: Echeverri Natalia , Fletcher Michelle , Timmons Douglas B. , Palin Hannah , Florez Laura , Carugno Jose
Published: May 2019

INTRODUCTION:

The insertion of a speculum is a common procedure performed during a gynecologic exam. With the intention to improve the patient experience, healthcare providers often use terms with unpleasant emotional content such as “it will feel uncomfortable” to guide patients through medical procedures. It is assumed that such words help patients but there is little evidence to support this belief. The objective of this study is to evaluate the impact of using phrases of anticipated discomfort on the perception of pain and discomfort during speculum exams.

METHODS:

A randomized single blind trial in patients undergoing speculum examination during their well woman gynecologic visit. Patients were randomized to the anticipated discomfort group were the following phrases were used “You are going to feel pressure” “This will be very uncomfortable” or the objective description group “I am going to introduce the speculum” and “I am going to open the speculum.” Patient were asked to rate the pain perceived during the speculum exam using the Wong-Baker facial grimace scale. Descriptive statistic was used to analyze the data.

RESULTS:

Both groups were similar regarding age, BMI, ethnicity, menopausal status and parity. Patients from the objective description group rate the pain perceived during the speculum exam at 0.8 ±SD: 0.8 compared to 2.9 ±SD: 1.5 (p<0.000). The objective group were also more likely to describe the pain as less than anticipated (p<0.000) in the post exam questionnaire.

CONCLUSION:

The use of phrases with unpleasant emotional content significantly worsened the pain perception during speculum examination.
No Association Between HPV Vaccination and Infertility in U.S. Females 18-33 Years Old [33B]
Authors: Mooney Katherine , LoConte Noelle , Conway James , Zhang Xiao , Schmuhl Nicholas B. , Lauer Jacob K.
Published: May 2019

INTRODUCTION:

Human papillomavirus (HPV) infections are associated with adverse human reproductive health outcomes: miscarriages, preterm delivery, lower pregnancy rates, and poor semen quality. Fecundity may also be reduced by surgery for HPV-related cervical dysplasia. HPV immunizations could improve fertility by preventing HPV infections. Claims have been made suggesting HPV vaccines negatively affect reproductive capacity. This study examined the relationship between HPV immunization status and infertility using data from a nationally-representative sample.

METHODS:

Data were analyzed from the 2013-2016 National Health and Nutrition Examination Surveys, which included queries regarding respondents' intentions and unsuccessful attempts to become pregnant, as a proxy for infertility. To confine the sample to respondents who were young enough to be offered HPV vaccine and old enough to have infertility concerns, only females between 18 and 33 years old (N=1,092) were included. Logistic regression models, stratified by marital status, were performed to examine the association between the proxy measure of infertility and HPV vaccination.

RESULTS:

Univariate models indicate that HPV vaccination is inversely associated with infertility among women who have ever been married (OR 0.46, 95% CI 0.23-0.93), but not associated for women never married (OR 0.87, 95% CI 0.39-1.95). After adjustment for age, race/ethnicity, family income levels, and education, there is no association between HPV vaccination and infertility for ever-married females (OR 0.61, 95% CI 0.35-1.08) or never-married females (OR 0.84, 95% CI 0.34-2.08).

CONCLUSION:

There was no association between HPV immunization and inability to become pregnant when desired. This information is valuable given public concerns regarding vaccine safety and persistently low HPV immunization rates.
HDAC6 & DNMT Inhibition Alter Immunogenicity of Ovarian Cancer Cells: A Rationale for Combination Therapy [39B]
Authors: Moufarrij Sara Maria , Srivastava Aneil , Hadley Melissa , Lopez Micael , Villagra Alejandro
Published: May 2019

INTRODUCTION:

Therapies that activate the immune system to fight cancer have shown robust responses in solid tumors. However, most patients, including those with ovarian cancer, do not respond to these therapies alone. We are testing the combination of epigenetic modifiers DNA methyltransferase inhibitor 5 azacytidine and selective histone deacetylase 6 inhibitor Nexturastat A, in stimulating immunogenesis in an ovarian cancer model.

METHODS:

We hypothesize that the combination of HDAC6i and 5-AZA will enhance tumor immunity alone and when used in combination. We used qRT-PCR to detect amplification of cytokines, Western blot for protein expression and cell culture in addition to flow cytometry to measure the cell types and protein expression in the ascites milieu in a murine ovarian cancer model.

RESULTS:

Immunoblots showed that PD-L1, a marker of poor prognosis in ovarian cancer, decreased after treatment with Nexturastat A and even more in combination with 5-AZA. Additionally, the combination therapy upregulated cytokines involved in the T cell and Natural Killer cell response. Treatment with the drug combination in a murine model of ovarian cancer significantly reduced tumor burden and prolonged survival. Flow cytometry analysis of ascites favored an immunogenic microenvironment.

CONCLUSION:

PD-L1 decreased after treatment with Nexturastat A and even more so when combined with AZA, while interferon stimulated genes were upregulated with combination treatment. We observed enhanced survival and decreased tumor burden in a murine ovarian cancer model when treated with Nexturastat A and 5-AZA, as well as a more favorable immune microenvironment in the mice treated with epigenetic drugs.
Medical Student Education in Pregnancy Options Counseling: A Systematic Review [2C]
Authors: Farmer Lauren E. , Clare Camille Angela
Published: May 2019

INTRODUCTION:

Background: Non-directive pregnancy options counseling is an important skill for medical students to learn as physicians of multiple specialties will counsel patients regarding their desired pregnancy outcome. APGO lists options counseling as a “shows how” skill for all undergraduate medical students. Despite this, it is only taught at 36% of medical schools with an average of 60 minutes spent per school. Thus, students and faculty have attempted to supplement existing curriculum due to concerns about medical student competency.

PURPOSE:

To review peer-reviewed literature on pregnancy options counseling in undergraduate medical education.

METHODS:

A systematic search of Google Scholar and PubMed for post-2000 literature using keywords, “pregnancy options counseling,” “medical student education,” “OSCE,” “student competency.” Inclusion criteria were English language studies of M.D. and D.O. programs in North America with a discussion of both pregnancy options counseling and medical education.

RESULTS:

Educational modalities used most frequently included objective structured clinical examinations (OSCEs) (57%), novel clinical and patient experiences (43%), faculty run workshops (38%) and online teaching modules (14%). The most popular timing of interventions was 3rd year OB/GYN and family medicine clerkships (71%). Students routinely left out the following topics in counseling: adoption, intimate partner violence and reproductive coercion.

CONCLUSION:

Common educational modalities utilized to supplement medical student education include online modules, clinical shadowing, novel clinical experiences, role play, and OSCEs. The optimal combination of these modalities has yet to be elicited. However, much work has been done in the last five years to advance the OSCE as a learning tool for options counseling.
Systematic Review of Access to Emergency Contraception for Sexual Assault Victims in U.S. Emergency Departments [3C]
Authors: Wang Michelle , Khodadadi Alexandra , Turan Janet , White Kari
Published: May 2019

INTRODUCTION:

We conducted a systematic review of the literature to assess the prevalence in hospital protocols and policies for providing emergency contraception (EC) to sexual assault survivors in US emergency departments (EDs).

METHODS:

We searched PubMed and CINAHL from inception to October 2017 for studies that assessed access to EC for sexual assault survivors in EDs. We included English-language studies that surveyed ED staff at US hospitals and reported the percentage of hospitals with policy on EC for sexual assault survivors and the frequency with which survivors were counseled, offered and received EC on-site. Secondary outcomes included the percentage of hospitals that provided prophylaxis for sexually transmitted infections (STIs) and HIV and offered STI and HIV testing.

RESULTS:

From 390 articles retrieved, 14 studies met the inclusion criteria. Eligible studies surveyed the staff and administrators at 3,314 hospitals. In eight of nine studies, 52-83% of hospitals had a policy on EC; a study published in 2000 reported 28% of hospitals with an EC policy. Additionally, 42-83% of hospitals provided EC counseling, 34-83% offered EC, and 45-81% had EC available to dispense onsite. Fewer studies reported on the secondary outcomes. Overall, 81-92% provided STI prophylaxis, 38-90% provided STI testing, 14-69% provided HIV prophylaxis, and 11-81% provided HIV testing.

CONCLUSION:

Our findings demonstrate significant variability in policies and practices to provide EC for sexual assault survivors across US hospital EDs. Identifying and reducing barriers to EC counseling and dispensing would ensure sexual assault survivors can access this essential service, regardless of their source of care.
Trends in Postpartum Uptake of Long-Acting Reversible Contraception Between 2012 and 2016 [4C]
Authors: Noon Brigit , Lerma Klaira , Kharsa Zena , Shaw Kate
Published: May 2019

INTRODUCTION:

This study aimed to evaluate trends in postpartum uptake of long-acting reversible contraception (LARC) at Stanford Children's Hospital between 2012 and 2016.

METHODS:

We reviewed medical records for all women delivering after 24-weeks gestation with the Stanford teaching service during 2012 and 2016. We documented and compared contraceptive plan at the time of hospital discharge, immediate postpartum uptake of LARC, and interval uptake of LARC by 8-weeks postpartum.

RESULTS:

Among 1141 deliveries in 2012 and 985 in 2016, 27.6% and 27.1% desired LARC at the time of hospital discharge, respectively. Immediate postpartum uptake increased from 2.9% in 2012 to 17.5% in 2016 (p<0.001). Among those receiving prenatal care at our institution, attendance at a postpartum visit was 75.6% (666/881) in 2012 and 82.3% in 2016 (548/666; p=0.002). In this sub-set, immediate uptake of LARC increased from 2.5% (22/881) to 16.2% (108/666; p<0.001), whereas interval uptake increased from 4.3% (38/881) to 5.1% (34/666; p<0.001). Among these patients and those who desired LARC, immediate uptake increased from 10.3% (23/223) to 64.9% (113/174; p<0.001), whereas interval uptake did not increase significantly (15.2% in 2012 and 10.3% in 2016, p=0.08). In a binary logistic regression analysis, younger age, public insurance, and multiparity were significantly associated with increased uptake in all sample sub-sets.

CONCLUSION:

Uptake of LARC by 8-weeks postpartum increased dramatically from 2012 to 2016. The observed increase was driven by an increase in immediate postpartum initiation. Future efforts should focus on identifying women who desire postpartum LARC prior to delivery and facilitating immediate postpartum insertion.
Medical Students Encounter Values Conflicts Frequently in Clerkships: A Need for Values Clarification Education [5C]
Authors: Chaudhari Sonal , Zuo Stephanie , Robinson Jennifer , Patel Silka
Published: May 2019

INTRODUCTION:

Few models of medical school clinical curricula emphasize values clarification (VC) education. VC is a psychotherapy technique that can help individuals increase awareness of personal values, reflect on personal moral dilemmas and allow values to be analyzed and clarified.

METHODS:

We surveyed students after they participated in a VC session, facilitated by trained faculty and centered around the topic of abortion, during their Women's Health (WH) clerkship at Johns Hopkins University School of Medicine. IRB committee approval was obtained (IRB 00106073).

RESULTS:

66% of medical students responded to our survey (n=115). 83% of students agreed or somewhat agreed that a session dedicated to values clarification regarding difficult patient scenarios would be beneficial during their clinical rotations. At least 68% of students reported encountering conflicts in which their values were different from their patients' in multiple clerkships. 79.1% completed more than one clerkship before WH. Of significance, students encountered values conflicts more frequently in WH clerkship compared to Surgery (n=71, p=0.013) and Neurology (n=36, p=0.002). After participation in our VC session, greater than 75% of students agreed or somewhat agreed that they gained increased awareness of personal values and values conflicts as well as increased empathy.

CONCLUSION:

VC education is essential in medical clinical curricula because students encounter difficult patient scenarios and values conflicts. Providing such education is not a time-consuming addition to clinical curriculum, as we were able to accomplish this in an hour for a group of 25-30 students. We encourage medical schools to endorse VC education in clinical medical curricula.
Surrogate Motherhood: Need for Continued Research and Comprehensive Education [6C]
Authors: Tedeschi Catherine , Bachmann Gloria A.
Published: May 2019

INTRODUCTION:

As assisted reproductive technology (ART) is continuously progressing and changing, society, the medical community and legal systems are struggling to keep pace. ART often challenges social norms, religious beliefs, and current legislation, with resultant negative outcomes at times. Professional societies are addressing this issue, but one area of research, that of surrogate motherhood, is limited. Informed consent and the safeguarding of gestational carriers must be examined to ensure their comprehensive education, counseling and protection.

METHODS:

A review of the PubMed database, Google Scholar, and other accessible information via Google was conducted.

RESULTS:

Though rates of surrogate pregnancies are on the rise, reaching over 3,400 gestational carriers in 2013, there are limited data regarding the repercussions for gestational carriers themselves. Moreover, the educational resources for potential surrogate mothers are scant. The MeSH heading “Surrogate Mothers” on the PubMed database registers only 1,583 hits, but a Google search of this term yields approximately 4,770,000 hits. When searching via Google Scholar, a more academic, yet accessible resource, this search term yields approximately 116,000 hits. Moreover, there is a lack of long-term follow-up on the surrogate mothers themselves, with few studies following up after 1 year.

CONCLUSION:

There appears to be insufficient patient education and a scarcity of comprehensive long-term research that should be addressed in order for the medical community to safeguard the emotional and physical health of gestational carriers.
Age, BMI, and Race as Independent Predictors for 30 Day Readmission After Total Laparoscopic Hysterectomy [8C]
Authors: Le Chi , Elsamadicy Emad A. , Brown Kelsei , Lee Jaclyn
Published: May 2019

INTRODUCTION:

Readmission after hysterectomy is being used as a proxy for quality of care. We aim to assess the roles of patient age, BMI, and race on 30 days readmission after total laparoscopic hysterectomy (TLH).

METHODS:

Medical records of 168 consecutive patients who underwent TLH at a major academic center between 2010 and 2012 were reviewed. Age, BMI, race, and status of 30-day readmission were collected. Non-readmitted and readmitted group were compared using Welch t-tests and Pearson's Chi-square tests with Yate's continuity correction.

RESULTS:

Among 168 patients reviewed, 15 (8.9%) patients had unplanned readmission within 30 days of TLH while 153 (91.1%) did not. There was a statistically significant difference in age between the two groups, and younger age was observed in the readmitted cohort (Readmitted: 32.6 years vs. Non-readmitted: 38.6 years, p=.00397). No significant difference BMI were identified between the 2 groups (Readmitted: 30.95 vs. Non-readmitted: 31.45, p=0.836). Among 133 Non-Hispanic White and 32 Black patients, readmission rates were higher among Black patients; however, the difference was not statistically significant (Black: 15.6% vs. White: 7.5%, p=0.276).

CONCLUSION:

Our study demonstrated the significance of patient's age in 30-days readmission after total laparoscopic hysterectomy. Moreover, BMI and race were not found to be predictors of readmission. Future studies are necessary evaluate risk factors for readmission to improve surgical outcomes and quality of care.
Assessment of Menstrual Product Financial Burden on Low-Income Patients [9C]
Authors: Trant Amelia A. , Espinal Mariana , Kisanga Edwina , Lee Illuzzi Jessica , Sheth Sangini Shah , Fan Linda L.
Published: May 2019

INTRODUCTION:

Anecdotal evidence indicates that low-income women in developed countries have difficulty affording menstrual products. Lack of access to menstrual products has been linked to truancy and negative psychosocial effects in school age-females and poor menstrual hygiene practices can increase risk of urogenital infections. This study aims to assess if the expense of menstrual products is a burden for low-income women.

METHODS:

In a cross-sectional study at two outpatient women's health practices at Yale-New Haven Hospital, patients were given an anonymous 21-question questionnaire to complete during their clinic visit. The study protocol was approved by the Institutional Review Board of record at Yale University and informed consent was obtained from all participants. Adult English and Spanish-speaking women of reproductive age were eligible for the study. Access and affordability of menstrual products was assessed on a four-point Likert scale.

RESULTS:

One hundred seventy patients were invited to participate, 155 completed the survey. Participants reported having difficulty affording menstrual products: most of the time 3%, sometimes 19%, rarely 19%, never 59%; 50% of patients reporting menstrual hygiene insecurity (lacking access most of the time or sometimes) had annual family incomes below $20,000. Sixty-seven percent of respondents could not recall any discussions with healthcare professionals about menstrual products.

CONCLUSION:

Menstrual hygiene insecurity is a common issue among women who are low-income and especially those living below the federal poverty level. Healthcare providers serving these populations should ask patients about menstrual product use and affordability to assess need.
Gynecological and Contraceptive Needs of Female Survivors of Sex Trafficking and Sexual Violence [13C]
Authors: Rajeev Pournami , Goddard Brian , Pearson-Ayala Savannah , Bach Sonya Chemouni , Ades Veronica
Published: May 2019

INTRODUCTION:

Survivors of sexual trauma need trauma-informed care, but their specific gynecologic needs have not been explored. This study aims to examine the gynecological and contraceptive needs among survivors who did present to a specialized gynecology clinic for trauma survivors. This data may help gynecologists who encounter patients with sexual trauma to better understand their medical needs.

METHODS:

This is a retrospective cohort study of patients at the EMPOWER Clinic for Survivors of Sex Trafficking and Sexual Violence. IRB approval and patient informed consent were obtained. Data were abstracted from electronic medical records, and stored and analyzed using REDCap.

RESULTS:

Data were available for 232 patients. Most patients presented to the clinic for a routine gynecological exam or due to gynecological symptoms. The most common chief complaints were dysmenorrhea, menorrhagia, and abdominal pain. Seventy percent of childbearing age patients were not on any form of effective contraception at the time of their intake visit. However, more than half of these patients with whom family planning was discussed accepted a new form of contraception, with 50% of these patients choosing oral contraceptive pills.

CONCLUSION:

Trauma survivors often present with routine gynecological complaints, and providers should be prepared to address these in addition to the trauma. Many patients were not using an effective form of contraception at intake, but a majority of patients who discussed family planning with the Ob/Gyn accepted a new form of contraception, suggesting that there may be a high unmet need for contraception in this population.
Predictors of Antenatal Seasonal Influenza Vaccination in an Underserved Population [15C]
Authors: Adams Jenna , Biswas Hope H. , Boulet Sheree L. , Haddad Lisa , Jamieson Denise J.
Published: May 2019

INTRODUCTION:

Uptake of seasonal influenza vaccination among pregnant women remains low despite recommendations supporting routine vaccination in this population at high risk for severe morbidity. We evaluated predictors of antenatal influenza vaccination in an underserved patient population.

METHODS:

We conducted a retrospective cohort study of all women with deliveries to Emory healthcare providers at Grady Memorial Hospital, a large safety-net hospital, between July 1, 2016 and June 30, 2018. Demographic and clinical characteristics were abstracted from electronic medical records. The Kotelchuk Index was used to assess prenatal care adequacy. Adjusted relative risks (aRRs) and 95% confidence intervals (CIs) for associations between demographic and clinical characteristics and receipt of influenza vaccine were calculated using multivariable log-binomial models. IRB approval was obtained for this study.

RESULTS:

Among 3,727 women with deliveries, most were non-Hispanic black (68.60%) and had Medicaid as their primary insurer for delivery (87.93%). The overall vaccination rate was 49.80% (1,856/3,727). Characteristics significantly associated with influenza vaccination in multivariable models were Hispanic ethnicity (aRR 1.44, 95% CI 1.11-1.88), transferring care between institutions (aRR 0.34, 95% CI, 0.29-0.41), and inadequate prenatal care (aRR 0.70, 95% CI, 0.64-0.75).

CONCLUSION:

Women with inadequate or discontinuous prenatal care were less likely than women with adequate prenatal care to receive a seasonal influenza vaccine. Hispanic ethnicity was associated with increased rates of influenza vaccination, even after controlling for interpretive language services. These findings highlight the importance of continuous, regular prenatal care in recommending and offering antenatal vaccinations to pregnant patients while supporting possible cultural differences in vaccine acceptance.
Influence of Depression on Maternal Outcomes [21C]
Authors: Packer Claire , Valent Amy
Published: May 2019

INTRODUCTION:

We sought to determine the differences in maternal pregnancy outcomes in patients with pre-existing major depressive disorder compared to unaffected women.

METHODS:

A retrospective cohort study comparing the rate of maternal outcomes among singleton, non-anomalous births in California to women with or without the diagnosis of depression between 2007 and 2011. Maternal outcomes of interest included pregestational diabetes (DM), gestational diabetes (GDM), cesarean delivery, postpartum hemorrhage (PPH), hypertensive disorders of pregnancy (preeclampsia or gestational hypertension), and maternal blood transfusion. Multivariate regression analyses and chi-square tests were employed for statistical comparisons and a p-value of less than 0.05 was used to indicate statistical significance.

RESULTS:

Of the 2,214,533 births in California, 18,775 (0.85%) women were diagnosed with depression. Depression was significantly associated with an increased risk of maternal morbidity and mortality, including DM (Adjusted Odds ratio [aOR] 1.85, 95% CI 1.63-2.10), GDM (aOR 1.33, 95% CI 1.27-1.40), cesarean delivery (aOR 1.05, 95% CI 1.01-1.09), PPH (aOR 1.80, 95% CI 1.68-1.94), maternal blood transfusion (aOR 1.19, 95% CI 0.77-1.84), hypertensive disorders of pregnancy (aOR 1.30, 95% CI 1.23-1.38), and stillbirth (OR 1.49, 95% CI 1.21-1.82) (Table 1).

CONCLUSION:

Women with depression are at increased risk for adverse maternal outcomes in pregnancy. The influence of pharmacologic and behavioral based interventions on these outcomes need to be explored.