bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing Treatment Options for Uterine Fibroids: An EHR-based Algorithm for Registry Recruitment [12H]
Authors: Hoffman Sarah , Westreich Daniel , Vines Anissa , Halladay Jacqueline , Pfaff Emily , Nicholson Wanda K.
Published: May 2017

INTRODUCTION:

COMPARE-UF is a national registry of women with uterine fibroids (UF) that will examine the effectiveness of different fibroid treatments on patient-centered outcomes. Electronic health records (EHR) may be used for efficient identification of eligible women within healthcare systems. An EHR-based algorithm was developed to identify women with symptomatic UF for recruitment into the PCORI-supported COMPARE-UF registry.

METHODS:

An iterative process was undertaken with a goal to maximize the positive predictive value (PPV) of the final algorithm. For the first algorithm, women were required to be age 18-54, have imaging confirming UFs or a diagnosis code for UF and no history of hysterectomy. The second algorithm required both imaging and at least 2 diagnoses codes for UF. The third algorithm required at least 2 diagnosis codes for UF on separate dates, and excluded patients who had UF detected during a prenatal or emergency department visits. Randomly selected charts were reviewed for each algorithm.

RESULTS:

The first algorithm identified 4,342 patients, with a PPV of 47% (95% CI: 39-56%) after 150 charts were reviewed with ultrasound evidence of UFs in 139 (93%). The second algorithm yielded 1,174 patients, with a PPV of 65% (95% CI: 50-79%) after reviewing 51 charts. The third algorithm yielded 465 patients, with a PPV of 76% (95% CI: 71-81%) after 300 chart reviews.

CONCLUSION:

An EHR algorithm can identify patients with UFs. However symptomatic UF cases can be challenging to distinguish from asymptomatic cases and require additional steps to confirm eligibility.
Retrospective Review of Prophylactic Bilateral Salpingectomy: Evaluation of Rates & Perioperative Complications [15H]
Authors: Bell Kristin
Published: May 2017

INTRODUCTION:

Ovarian cancer is the most lethal gynecologic malignancy. Current evidence suggests that high grade serous ovarian cancer originates in the fallopian tube. It is thought that bilateral salpingectomy (BS) will decrease the risk of ovarian cancer. Our goal is to observe the trend in rates of BS at our institution over the last three years, and evaluate operative time and complications in those patients undergoing BS.

METHODS:

A retrospective chart review was performed. Records of patients who underwent hysterectomy with and without salpingectomy for benign conditions from January 1, 2012 through December 31, 2014 were reviewed. Charts were identified using CPT codes. Exclusion criteria included malignant pathology and history of bleeding disorder. Statistical Analysis was performed, using Student's t-test for continuous variables and the Chi-square test for categorical variables.

RESULTS:

In total 921 samples were collected. A significant increase in the rate of BS was seen over the observed time period (27.8% 2012, 41.9% 2013, 46.8% 2014, P < 0.0001). Length of procedure, estimated blood loss, intraoperative/postoperative complications and unplanned readmissions were the same in the BS and no BS groups. BS was more commonly performed in abdominal and laparoscopic hysterectomies compared to vaginal and robotic hysterectomies.

CONCLUSION:

Our findings demonstrate an increase in the performance of BS in benign procedures at our institution. There were no increased operative risks associated with performing BS at the time of hysterectomy. These results are consistent with the results of other facilities and should encourage routine planning for BS at the time of benign hysterectomy.
Who Should Manage Vulvar Disorders? A National Survey of Gynecology and Dermatology Residents [16H]
Authors: Yeung Jennifer , Crisp Catrina , Mazloomdoost Donna , Kleeman Steven , Pauls Rachel
Published: May 2017

INTRODUCTION:

Vulvar disorders are unique, and it is unclear which specialty is responsible for screening the vulva. We sought to survey behaviors, knowledge and comfort of residents in obstetrics/gynecology (OB/Gyn) and dermatology regarding vulvar disease and evaluate differences among programs.

METHODS:

This was a cross-sectional, web-based, national survey of OB/Gyn and dermatology residents. Program coordinator email addresses were obtained from FREIDA Online®. Two separate emails requested coordinators forward the author-designed survey to current residents.

RESULTS:

Two hundred five surveys were completed: 67% OB/Gyn and 33% dermatology. The majority of both OB/Gyn (84%) and dermatology (77%) residents believed OB/Gyns are responsible for screening the vulva. Most OB/Gyn and dermatology residents reported thoroughly inspecting the vulvar area for lesions (62%), though 19% of dermatology residents reported never examining the vulva. Concerning comfort with managing vulvar lesions, only 2% of the total sample felt “very comfortable”. Regarding training, 53% overall reported this as “adequate”, whereas 4% believed they had “very good” training. One-fifth of OB/Gyn residents were “dissatisfied” with their vulvar disorders training. Most residents correctly identified images of vulvar melanoma (80%), squamous cell carcinoma (68%), and lichen sclerosus (98%). Ob/Gyn residents were more likely to correctly respond to items regarding vulvar melanomas (p=.032), biopsy performance (p < .001), and lichen sclerosus diagnosis (p < .001).

CONCLUSION:

Both cohorts believed OB/Gyns were the appropriate group to screen the vulva. Nevertheless, dermatologists should be able to and offer to perform this exam if not completed recently. A standardized curriculum regarding vulvar disorders could improve training in both specialties.
New Case-Complexity Score for Benign Minimally Invasive Hysterectomy- One Step Beyond the Current CPT Codes [32H]
Authors: Moawad Gaby , Tyan Paul , Marfori Cherie , Abi-Khalil Elias , Amdur Richard
Published: May 2017

INTRODUCTION:

Evidence has shown several preoperative and intraoperative factors to clearly influence the complexity of minimally invasive hysterectomy. The only factor currently taken into consideration is uterine weight.

METHODS:

Retrospective cohort analysis of 196 consecutive patients undergoing robotic or laparoscopic hysterectomy for benign indications by fellowship-trained minimally invasive gynecologists at a single urban teaching university hospital.

RESULTS:

Our regression model predicting operative time using age, race, uterine weight, history of myomectomy, ovarian cystectomy, lysis of adhesions, ureterolysis, excision of endometriosis, and uterine artery ligation was significant (F=16.90, p < .0001) with R2 = .31. The variables that were significantly independently associated with operative time included log uterine weight (p < .0001), history of myomectomy (p=.014), ovarian cystectomy (p=.061), lysis of adhesions (p=.013), and excision of endometriosis (p=.027). Parameter estimates for each of these predictors were used to calculate a complexity score. This score was strongly correlated with operative time (Pearson r = .55, p < .0001). The association of the new complexity score with estimated blood loss (EBL) (Spearman r = .32, p < .0001), length of stay (LOS) (Spearman r = .15, p=.038), and cost decile (Spearman r = .21, p=.0035) were all significant. The Spearman r’s for the uterine weight > 250 g criterion with operative time, EBL, LOS, and cost decile were .41, .20, .07, and .15.

CONCLUSION:

In addition to uterine weight, history of myomectomy and numerous concomitant procedure variables (ovarian cystectomy, lysis of adhesions, excision of endometriosis), significantly affect case-complexity. The current model (250 g) does not adequately reflect case complexity.
Uterine Curettage Versus Presumptive Methotrexate for Non-Viable Pregnancy of Unknown Location [33H]
Authors: Parks Melissa , Barnhart Kurt , Howard David
Published: May 2017

INTRODUCTION:

When managing a non-viable pregnancy of unknown location (PUL), it is unknown which factors influence the decision to perform a uterine curettage versus presumptive administration of methotrexate.

METHODS:

A prospective, anonymous electronic survey of PUL case scenarios was administered to physicians registered with the American Medical Association Physician Masterfile and to all Obstetrics and Gynecology residents and academic faculty located in the United States.

RESULTS:

A total of 214 physicians responded. When presented with a patient diagnosed with a PUL by transvaginal ultrasound and serial βhCG measurements demonstrating an inappropriate trend for a viable pregnancy, 78 (37.0%) would offer uterine curettage before administrating methotrexate while 67 (31.7%) would offer methotrexate presumptively. The odds of choosing uterine curettage was more than four-fold higher among academic physicians compared to resident physicians (adjusted OR 4.05, 95% CI 1.62-10.10). There was no difference between private practice physicians and resident physicians. Compared to physicians in the Northeast, physicians in the South were much more likely to select uterine curettage as their initial management strategy (adjusted OR 2.48, 95% CI 0.99-6.20).

CONCLUSION:

Resident physicians appear to be significantly more likely to presumptively administer methotrexate compared to academic physicians in the context of a non-viable PUL. If confirmed by larger studies, this finding has direct implications for future resident education.
Can We Predict Emergent Delivery in Cases of Suspected Placenta Accreta? [36H]
Authors: Razavi Armin , Fields Jessica , Chasen Stephen
Published: May 2017

INTRODUCTION:

To identify factors associated with emergent delivery in women with a suspected placenta accreta.

METHODS:

This was a retrospective review of pregnancies with sonographic features of placenta accreta delivering at our institution from 2006-2016. Demographic information, antepartum course and delivery information were extracted from electronic medical records. Chi square analysis, Fisher’s exact test, Mann Whitney U tests and logistic regression were used in statistical analysis.

RESULTS:

Fifty-four patients with suspected placenta accreta were included. Nineteen patients (35.2%) had an emergent delivery and 42 (77.8%) had a confirmed accreta on pathology. Those undergoing emergent delivery were more likely to have one or more bleeding episodes prior to the time of delivery than those with scheduled delivery (73.7% vs. 37.1%; p=.01), and these patients delivered at earlier gestational ages than those without bleeding (33 vs 35 weeks, p = 0.03). Regression identified antepartum bleeding as an independent risk factor for emergent delivery, OR 4.7 [1.4-16.2]. Placenta previa, history of preterm birth, short cervix and prior uterine surgery were not predictive of emergent delivery. The median number of packed red blood cell units (PRBCs) transfused was greater in the emergent delivery group (4 vs 2, p=0.007) although ICU admission and length of hospital stay did not differ.

CONCLUSION:

Women with suspected placenta accreta who experience antepartum bleeding are more likely to require emergent delivery and have hemorrhagic morbidity. In those with one or more episodes of antepartum bleeding, earlier scheduled delivery could reduce maternal morbidity by reducing the rate of emergent delivery.
Cesarean Sections for Labor Arrest Disorders: Are We Moving to Cesarean Section Too Soon? [38H]
Authors: Smrekar Lisa M. , Perlow Jordan H. , Gerkin Richard D.
Published: May 2017

INTRODUCTION:

Contemporary studies show that active phase of labor begins later and that labor may take longer to progress than previously thought. The rising cesarean section (C-section) rate has sparked focus on preventing the first C-section to minimize morbidity.

Objective:

To determine the percentage of women given adequate time in labor prior to C-section for labor arrest.

METHODS:

Retrospective review of C-sections for labor arrest disorders at Banner University Medical Center: January 1, 2013- December 31, 2013. Descriptive analysis was performed with means ± standard deviation or percentages. Comparisons used T-tests for continuous variables, χ2 tests for categorical variables, and logistic regression models were performed. A two-tailed P value less than .05 was considered statistically significant.

RESULTS:

155 women met inclusion criteria. 43.2% were given adequate time to progress in labor prior to C-section. Teaching service patients were significantly more likely to be given adequate time to progress compared to patients of other physicians (OR 2.91). For each additional centimeter of dilation at time of C-section patients had a 27% increase in having had adequate time to progress (OR 1.27). There was no significant difference in parity, age, body mass index, ethnicity, or spontaneous labor vs labor induction in women given adequate or inadequate time to progress.

CONCLUSION:

The majority of C-sections for labor arrest disorders were performed too soon, suggesting an opportunity to reduce the overall number of C-sections through physician education. We suggest other centers consider such internal reviews, which ultimately may contribute to a reduction in cesarean deliveries and associated morbidities.
Modern Learning: How Today’s Obstetrics and Gynecology Residents Gain Knowledge [2I]
Authors: Friedman M. Alexandra , Adjei Naomi , Wenstrom Katharine
Published: May 2017

INTRODUCTION:

Little is known about OB-GYN residents’ habits or preferences with regard to self-education. We investigated current resident learning behaviors and preferences, as well as attitudes towards podcasting as an educational tool.

METHODS:

A 28 question survey was generated to query resident self-education generally and genetics education specifically. An invitation to complete the online survey was sent to all ACGME Program Directors, asking them to forward the survey to their residents. Data was collected and analyzed using Qualtrics Software.

RESULTS:

195 residents from 51/292 (17.5%) programs participated in the study. Average age was 28.9 years (SD 2.3 years), 85% were female, 13% were male. Half of residents (51%) reported spending between three and five hours a week on self-directed learning activities, excluding lectures, with 31% spending even less time, between zero and two hours. Residents reported they most commonly used UptoDate (129, 66%), Google (121, 62%), and Guidelines/Practice Bulletins (100, 43%) for learning. Guidelines and Practice Bulletins were considered very helpful for learning by 86% (167/195) followed by UpToDate (151, 77%). Only 35% (70) found textbooks helpful. A majority of residents reported they would be very likely to complete residency curriculum podcasts lasting 10 minutes (78%) or 20 minutes (63%). Residents would listen to podcasts while commuting to work (142, 78%), doing household chores (104, 53%), or exercising (50%).

CONCLUSION:

Residents spend five hours or less on self-education per week, and prefer concise, easily accessible learning modalities. Podcasts may be a useful educational tool for the modern OB-GYN resident.
A Prospective Trial: Traditional Versus Video-Based Teaching for Minimally Invasive Gynecologic Surgery [5I]
Authors: Truong Mireille , Tobias Claire , Ratan Rini
Published: May 2017

INTRODUCTION:

To compare traditional versus video-based education in gynecologic surgery on task-specific cognitive and surgical skills performance among millennial trainees. To evaluate the impact of learning preference on performance.

METHODS:

Prospective study in academic medical center. OBGYN residents and medical students on gynecology were assigned to traditional (TT) or video-based (VBT) training for total laparoscopic hysterectomy skills. TT included routine didactic and clinical instruction. VBT additionally included two types of videos: 1) cognitive, 2) psychomotor skills-based. Participants received pre- and post-intervention knowledge and skills assessments. The VARK© questionnaire determined learning preference. Change in assessment scores was compared. The relationship between learning preference, intervention group, and change in assessment scores was analyzed.

RESULTS:

120 students (n=59 VBT v. n=61 TT) and 24 residents (n=12 per group) participated. Mean improvement in knowledge assessment score was 8.65 for VBT v. 7.03 for TT (p=0.02) for medical students, and 4.17 for VBT v. 4.09 for TT (p=0.98) for residents. Mean skills test score was 6.22 with VBT v. 4.28 with TT (p less than 0.001) for students, and 2.45 with VBT v. 0.36 with TT (p=0.04) for residents. Among students, as visual learning preference increased, change in knowledge assessment score increased (p=0.04, CI 0.01-0.49). A similar trend was seen with auditory learning preference (p=0.04, CI 0.01-0.56). Among residents, as auditory learning preference increased, change in skills assessment score increased (p=0.03, CI 0.08-1.34).

CONCLUSION:

Video-based teaching is an effective educational tool in gynecologic surgery. Cognitive and skills-based performance may be enhanced among individuals with visual and/or auditory learning preferences.
Communication Preferences and Norms Among Medical Students Entering Obstetrics and Gynecology [6I]
Authors: Page-Ramsey Sarah M. , Purusothaman Vaishnavi , Miller Katherine , Ramsey Patrick S.
Published: May 2017

INTRODUCTION:

Global and mobile technology has reshaped communication in our society, impacting our next generation of OBGYNs. Our objective was to determine healthcare communication preferences among medical students entering OBGYN.

METHODS:

We surveyed medical students attending the American College of Obstetricians and Gynecologists Annual Medical Student Course from 2012-2014 regarding communicating results with patients, communication with other healthcare providers, answering patient questions, and counseling patients. Modes of communication included face-to-face, telephone, physician extenders, voicemail message, e-mail, text messaging, secure messaging, postal mail, and social networking.

RESULTS:

454 of 488 (93%) students from 45 states responded. Students would communicate normal results with patients by telephone (70%), physician extender (54%), secure messaging (50%), face-to-face (42%), postal mail (27%), e-mail (26%), voicemail message (19%), and text messaging (9%). For abnormal results, face-to-face communication (78%) was most common followed by telephone (32%), physician extenders (13%), and rarely voicemail messaging (2%), text messaging (< 1%), and snail-mail (3%). For general patient questions, students would use telephone (69%), face-to-face (47%) communication, secure messaging (45%), e-mail (43%), and text messaging (9%). When counseling patients, students were most likely to support face-to-face communication (80%) and very unlikely to choose text messaging (1%).

CONCLUSION:

Students planning a career in OBGYN will use multimodal communications with patients. Face-to-face, telephone, physician extenders, and secure messaging are commonly used. Postal mail and social networking are less common. Students plan to use text messaging and e-mail to communicate with patients in some situations, but not typically for abnormal results or counseling.
A Survey of Mobile App Use Among California Obstetrics and Gynecology Residents [8I]
Authors: Perry Rachel , Burns Roshan , Simon-Freeman Rebecca
Published: May 2017

INTRODUCTION:

Mobile applications (apps) are increasingly used in the clinical setting. We aimed to describe the attitudes and practices regarding OB/GYN-related mobile apps among OB/GYN residents.

METHODS:

We sent web-based questionnaires to residents at all 17 California OB/GYN programs. Responses were analyzed using descriptive and chi-square statistics.

RESULTS:

The survey was completed by 197 residents (response rate 51%). All respondents owned mobile devices (100% smartphone, 74% tablet), and 95% used apps in the clinical setting. The most commonly used OB/GYN-related apps were pregnancy wheels (84%), cervical cancer screening algorithms (68%), and contraceptive eligibility guidelines (47%). Fewer (52%) residents recommended apps to patients, many citing not knowing of any. The majority of residents (62%) used mobile apps for their own learning, most commonly the American College of Obstetricians and Gynecologists app. Most chose apps based on recommendations from other residents. Residents viewed mobile technology as an important clinical tool (92%) that improves efficiency (89%). Mobile app use was not associated with gender, age, or year in residency (p>0.05 for each).

CONCLUSION:

Mobile technology and OB/GYN-related app use are ubiquitous among California OB/GYN residents, who feel that apps enhance their ability to care for patients. Because residents primarily choose apps based on the recommendation of other residents, leaders in resident education may consider evaluating app content and providing recommendations for app use. There is also opportunity to expand mobile app technology as a learning interface to enhance resident education.
Assessment of Fetal Ultrasound Training for Obstetrics and Gynecology Residents [24I]
Authors: Sulmers Christine , Diaz-Sylvester Paula , Cox Jill , Han Heeyoung , Delfino Kristin , Taylor Funminiyi
Published: May 2017

INTRODUCTION:

Accreditation Council for Graduate Medical Education (ACGME) describes “the full range of commonly employed obstetrical diagnostic procedures, including ultrasonography” as one of the critical competencies required for graduation from an Obstetrics and Gynecology (Ob/Gyn) residency. However, prior studies identified a core curriculum deficit in residency programs. We explored these gaps to determine if they are worth addressing through future interventions.

METHODS:

A needs assessment survey was disseminated to all ACGME-approved Ob/Gyn residency programs in the USA.

RESULTS:

One-hundred-forty-four residents completed the survey. Of these, 73.6% had an ultrasound curriculum, of which 77.7% was accessible. Sonographers and faculty were rated as the principal educators. Almost half noted no checklist of competencies during their training, despite the fact that 63.2% were assessed via direct patient observations. Most frequent perceived knowledge deficits included: principle of as low as reasonably achievable (ALARA) and effect of frequency on resolution. Most frequent perceived performance deficits were skill in performing the anatomic survey and diagnosing chorionicity/amnionicity. The majority of respondents felt comfortable teaching/supervising basic obstetric ultrasound except anatomy ultrasounds and cervical length. Assessment of proficiency demonstrated weaknesses in the concept of ALARA, effect of frequency on image quality and identification of suitable crown rump length image. Overall, 76.3% desired more obstetric ultrasound training. Lack of first trimester ultrasounds and insufficient time were listed the most common obstacles to education.

CONCLUSION:

Additional obstetric ultrasound training for Ob/Gyn residents appears necessary. Improvements in designing an accessible curriculum and formally assessing competencies is fundamental for improving Ob/Gyn training programs.
Attitudes and Self-Reported Competencies in Advocacy Among OB/GYN Residents [25I]
Authors: Hall Evelyn , Quinlan Maura , Gerber Susan
Published: May 2017

INTRODUCTION:

The American College of Obstetricians and Gynecologists recognizes that education and training in advocacy is an important component of postgraduate education. However, there is little published literature on how to best teach advocacy to residents.

METHODS:

We administered an IRB-approved, self-reported, cross-sectional study of ob/gyn residents at Northwestern. The survey employed a 5-point Likert scale and was designed to assess residents’ experiences with advocacy training.

RESULTS:

Forty of 46 residents completed the survey. Among respondents, 95% felt that political advocacy is important to the field of ob/gyn, 92.5% believed government policies will affect their career, and 90% believed that formal training in advocacy and policy should be a part of residency training. Yet, only 38.4% felt that they had at least a basic understanding of Medicare billing and reimbursement policy, and 40% felt that their residency program encouraged advocacy. Residents did not feel that testing advocacy on national exams would improve their knowledge base in the area. While involvement in advocacy was common during medical school (90%), only 22.5% of residents were currently engaged in advocacy activities, and 27.5% were undecided if they would engage in advocacy during training. Common barriers reported were time, stress, and lack of knowledge on how to become meaningfully involved in advocacy work.

CONCLUSION:

Residents show high interest in advocacy, yet experience multiple barriers to becoming involved and report knowledge gaps on specific policy topics. Further research is needed to improve education and opportunities in advocacy for residents.
Impact of the Universal Adoption of Ring Block Anesthesia Pre-Circumcision in a Tertiary Care Center [26I]
Authors: Akinlaja Olukayode , Beck Roxanne , Josephsen Traci , Raper Mandi
Published: May 2017

INTRODUCTION:

Neonatal circumcision causes behavioral and physiologic changes consistent with the perception of pain. Ring block anesthesia pre-circumcision leads to a smaller increase in heart rate and respiratory rate. They demonstrated less arousal during each operative interval, less crying and a smaller decrease in oxygen saturation compared to infants not receiving anesthesia. A Joint commission site visit to our institution in March 2014 prompted the adoption of pre-circumcision anesthesia preferably ring block in April 2014 with the mindset of providing our pediatric patients with the same high quality care during a painful procedure.

METHODS:

A descriptive analysis of circumcision related data pertaining to the use of ring block anesthesia during circumcisions performed at Erlanger tertiary care facilities from March 2013 through March 2015.

RESULTS:

The use of ring block anesthesia application increased to 94.1% (n= 1394) out of 1482 post adoption compared to the prior 41.1% (n=727) out of 1770). Of note is the reduction in the total number of circumcision done in the hospital from n=1770 between March 2013 and 2014 to n=1394 between April 2014 and March 2015 of the study period.

CONCLUSION:

The near perfect implementation of ring block anesthesia pre-neonatal circumcision does illustrate the importance of hospital encouraged compliance in improving the quality of medical practice.
Impact of Nightfloat on Obstetrics and Gynecology Resident Education [27I]
Authors: Fenton Alexandra , Dangel Alissa
Published: May 2017

INTRODUCTION:

Nightfloat rotations are common in Obstetrics and Gynecology residency programs. The impact of this type of schedule on resident education in OB/Gyn has not been evaluated. This study was initiated to determine how the scheduling challenges of nightfloat rotations may impact OB/Gyn residents’ ability to participate in educational opportunities.

METHODS:

A cross-sectional study was conducted via two surveys. One survey was sent to all U.S. OB/Gyn residency program coordinators to collect information on their rotation structure and educational activities. A separate survey was sent to residents in these programs to evaluate their perspective on participation in educational activities while on nightfloat rotations.

RESULTS:

58 program directors (24.8% response rate) and 202 residents (16.1% response rate) from 54 programs responded. Of the program coordinators who responded, 98.2% reported having nightfloat rotation. Of these, only 8.8% had nightfloat specific educational activities. Attendance at regular didactic sessions was required by 33.9% of programs, however 76.9% of residents felt that they were not alert during these sessions. The survey also revealed that 66.4% of residents thought that their educational experience on nightfloat could be improved but most stated that required attendance at didactics would be ineffective. Residents’ suggestions for alternative options included ideas such as dedicated modules and recordings of regular didactic sessions.

CONCLUSION:

There is a need to improve the educational experience for residents on nightfloat rotations.
Impact of After Hour Availability of Gynecological Surgical and Clinical Supplies on Resident Satisfaction [29I]
Authors: Rosa Paola , Lospinoso Joshua , Weir Larissa , Miller Caela R.
Published: May 2017

INTRODUCTION:

We studied if changing the availability of key surgical instruments and clinical supplies improved resident experience when treating gynecologic patients after hours.

METHODS:

Eighteen surveys were distributed to San Antonio Uniformed Services Health Education Consortium Obstetric/Gynecology (OB/GYN) residents. The survey was a five point Likert scale that focused on the opinions of residents regarding the availability of needed equipment, and their ability to evaluate and manage patients outside regular clinic hours. A comprehensive kit was then developed with essential supplies and made readily accessible to residents in the OB/GYN clinic and the emergency department. The same five point Likert scale survey was redistributed a year later. Statistical analysis was conducted by modeling survey responses with a cumulative (ordinal) logistic model. Cumulative logistic regression assessed whether Gynecologic call kit availability increased resident satisfaction while controlling for respondent year level and question-level idiosyncrasy.

RESULTS:

In our model, the creation of a Gynecologic call kit had a strong, positive, and statistically significant effect on improving resident satisfaction on surveys (P= < .005). Compared to a survey response after the call kit was available, a pre-intervention response was 13.2 times as likely to be one value worse on the Likert scale after controlling for resident year group, question and survey idiosyncrasies.

CONCLUSION:

Analysis of our survey responses concluded that clinical supply accessibility after hours is essential for resident satisfaction and the provision of quality patient care. Surveys showed increased resident confidence post intervention in their ability to appropriately treat patients and handle clinical emergencies.
Towards Prevention of the Primary Cesarean Section: A Multi-Factorial Approach [31I]
Authors: Runyan Aliye , Schiwek Jacqueline , Dudick Steven , Tamakuwala Sejal , Dai Jing , Puder Karoline
Published: May 2017

INTRODUCTION:

To determine factors that influence the rate of primary Cesarean delivery within Detroit Medical Center (DMC), and whether indications for primary cesarean delivery fall within American College of Obstetricians and Gynecologists and SMFM recommendations. The primary Cesarean delivery rate for DMC hospitals for January - July 2014 ranges from 10.3 to 15.2% at our academic medical center, and from 10.6 to 21.5% at our community hospital. We looked at factors that contribute to this variability so that our hospitals may develop strategies to decrease rates of primary Cesarean delivery.

METHODS:

Retrospective chart review of 6 months of primary Cesarean deliveries in 2014 to determine indications. Survey to assess attitudes and behaviors in regards to provider threshold for calling a primary Cesarean, as well as resident and junior attending willingness to question decisions made by their seniors.

RESULTS:

The average age of women who had primary Cesareans was 26, the prior vaginal deliveries ranged from 0 to 8 with the majority of women (65.3%) having no prior vaginal deliveries, with a mean gestational age of 38 weeks. The most listed indications for Cesarean were FHT concern (51%) and category 2 tracing (47%). Fetal malpresentation (20%) and failed induction (15%) were also found in higher proportion.

CONCLUSION:

In order to foster dialogue regarding appropriate indications for Cesarean deliveries, it is good practice for a hospital system to perform self-assessment in the form of objective review as well as CME on how provider behavior can influence rate of Cesarean deliveries. Knowing the listed indications helps to focus on methods for prevention.
Randomized Trial of Self-Paced vs. Group Introduction to Open Surgical Skills Curriculum [34I]
Authors: Chen Lucy , Fuller Tobi , Kho Kimberly A.
Published: May 2017

INTRODUCTION:

At UT Southwestern/Parkland residency program, incoming interns are traditionally taught core open surgical skills in a group setting by viewing 12 instructional videos consecutively followed by individual pre-testing. We sought to determine if introduction to open surgical skills via self-paced viewing of video tutorials, as opposed to traditional group viewing, results in improved surgical skill acquisition in OBGYN interns as measured by higher proficiency score with decreased workload stress and anxiety.

METHODS:

A randomized control trial was conducted in which OBGYN PGY-1 residents in 2015 and 2016 (N=36) were introduced to basic open surgical skills, such as knot tying and suturing, by viewing 12 video tutorials produced at UTSW (http://www.utsouthwestern.edu/education/medical-school/departments/surgery/minimally-invasive-surgery/simulation-training/video-tutorials.html). Residents were randomized to two groups: group viewing versus self-paced viewing. Validated proficiency score was measured based on time and accuracy while workload and anxiety were measured by pre-and post-testing surveys using the NASA-TLX and STAI-6 questionnaires.

RESULTS:

There was no significant difference in proficiency score between the group versus self-paced viewing in 8 out of 12 tasks using the Wilcoxon signed rank test (P>0.10). There was no statistically significant differences in workload stress based on the NASA-TLX questionnaire (P=0.399) or self-reported anxiety based on the STAI-6 questionnaire (P=0.607).

CONCLUSION:

Contrary to recent educational data suggesting self-paced learning may improve outcomes, viewing instructional videos in a group setting continues to be a time efficient method to introduce basic open surgical skills to incoming OBGYN interns.
HybridLab Learning Method. III. Residual Value of Gynecological Clinical Skills [35I]
Authors: Nadisauskiene Ruta , Vaitkiene Daiva , Barilienė Sonata , Andriejaite Ieva , Malakauskienė Laura , Pukenyte Evelina
Published: May 2017

INTRODUCTION:

The aim was to evaluate the retention of clinical skills over time with or without the use of a checklist reminder strategy.

METHODS:

The 5th year students in OB/GYN rotation gain gynecological patient investigation skills (gynecologic history collection, breast examination, gynecological exam, Pap smear taking) by HybridLab method. The 1st structured standardized assessment was performed during rotation. After 4-12 months, 50 students randomly took part in the 2nd control investigation without checklist reminder (group A) or with (group B) in an identical clinical task.

RESULTS:

Initial evaluation of the results between the two groups (99.34 and 99.36%) and the average time interval between assessments (7.64 ± 2.8 and 1.6 ± 9:36) did not differ in both groups (P> 0.05). The mean evaluation of practical skills of 2nd assessment was 75.6% (SD 17.0) of students in group A and 88.6% (SD 14.0) in group B (p=0,005). The total valuation change (with and without a reminder) was 17.1% (SD 16.7). Group A demonstrated reduced performance by 23.4% (16.8), group B — by 10.8% (SD 14.2) (p=0,006). The duration between assessments had no influence on the performance results. Based on ROC test, we determined that the ratio of chances OR [95%C.I] for gynecological skills evaluation change less 15% in group B (after reminding) was 6.729 [1.939-23.356]; the ratio of chances OR [95%C.I] for gynecological history taking evaluation change less 5% was 11.0 [2.587-46.779].

CONCLUSION:

HybridLab method ensures achievement of necessary clinical skills, reminder significantly boosters their retention.
Faculty and Resident Perception of a Standardized Surgical Approach and Teaching Tool for Primary Cesarean Delivery [36I]
Authors: Pallister Megan , Ballas Jerasimos , Eppes Catherine , Belfort Michael A. , Davidson Christina
Published: May 2017

INTRODUCTION:

In 2014, our department developed a surgical site infection (SSI) care bundle in an effort to reduce the SSI rate associated with cesarean delivery (CD). A component to this bundle was to reduce operative time by developing a standardized best-practices approach to CD. The objective of this study is to evaluate faculty and resident perception of surgical preparedness and learning environment before and after implementation of this standardized approach.

METHODS:

An online questionnaire was distributed to all residents and faculty prior to implementation of the surgical guidelines. The survey assessed attitudes towards technical proficiency, surgical preparedness, resources for surgical education and evaluation of resident surgical competency. The standardized approach was introduced as a departmental guideline; a PowerPoint presentation; and a high-resolution, first-person instructional video utilizing a head-mounted Go-Pro camera. A follow-up resident survey was conducted upon completion of their rotation and after 6 months post-implementation for the faculty.

RESULTS:

There was a significant increase in positive resident responses when asked if faculty spent time teaching surgical skills in the operating room. In response to whether a standardized surgical approach reduces autonomy there were significantly more “strongly disagree” and “disagree” responses POST group. Amongst faculty, there were significantly more negative responses and fewer positive responses post-implementation when asked whether a standardized approach would improve surgeons’ skills, improve team working skills or reduce the length of surgical time.

CONCLUSION:

Despite negative faculty perception of a standardized approach and teaching tool for primary CD, residents perceived greater teaching opportunities without loss of autonomy in the operating room.
Cost Utility Analysis of Methotrexate Versus Actinomycin-D in Low Risk Gestational Trophoblastic Neoplasia [2J]
Authors: Geisler John , Manahan Kelly
Published: May 2017

INTRODUCTION:

To determine the most cost effective first line regimen for women with low risk gestational trophoblastic neoplasia (GTN) (WHO risk score 0-4 and no choriocarcinoma).

METHODS:

Markov decision model (1000 patients) was used to analyze published data GOG 174. Arm 1 was weekly methotrexate at 30 mg/m2 weekly while arm 2 was actinomycin-D 1.25 mg/m2 biweekly. Costs were based on average sale price (ASP) +6%. Utility values were determined by rating scale.

RESULTS:

The mean cost of therapy for methotrexate arm was $11,970 (95%CI $11,149-$12,791). The mean cost of the actinomycin-D arm was $26,865 ($26,780-$26,950). Weekly methotrexate dominated actinomycin-D as first line therapy.

CONCLUSION:

First line therapy of low risk GTN should be weekly methotrexate.
When to Worry About Cancer: Factors Associated With a Concurrent Carcinoma in Borderline Epithelial Ovarian Tumors [9J]
Authors: Sullivan Mackenzie , Modesitt Susan
Published: May 2017

INTRODUCTION:

Borderline ovarian tumors are technically benign yet can actually metastasize, recur, or progress to a carcinoma (typically low grade). The objective was to assess the outcomes of epithelial ovarian borderline tumors to determine factors potentially implicated in adverse outcomes.

METHODS:

The pathology and cancer databases were searched at an academic tertiary care center to identify all borderline tumors. Clinical data were abstracted via chart review. Borderline cases with/without a concurrent carcinoma were compared using relevant statistical tests and factors for any recurrence assessed.

RESULTS:

A total of 123 borderline patients were identified. The mean age at diagnosis was 51.3 years, mean BMI was 31.5 kg/m2, 82% were white, 83.7% underwent BSO +/- hysterectomy/omentectomy, median time to recurrence was 16.8 months, and over 90% were disease free. An additional ovarian cancer diagnosis occurred in 25% (half low grade, three high grade, and 11 unknown grade). Compared to the borderline only group, the carcinoma/borderline patients did not differ significantly in age, race, BMI, parity, HRT, tobacco use, or personal/family cancer history, but were significantly more likely to be postmenopausal and have an elevated Ca-125. Additionally, the cancer patients had significantly decreased serous histology and increased mucinous or endometrioid histologies.

CONCLUSION:

Concurrent ovarian cancer is common in women with borderline tumors and is associated with postmenopausal status and elevated Ca-125 levels. While the majority of cancers were still serous, there was a higher percentage of mucinous and endometrioid histologies. These factors should alert clinicians to a potential increased likelihood of concurrent cancer.
Beta Adrenergic Blockade Is Feasible During Primary Treatment for Ovarian Cancer [10J]
Authors: Ramondetta Lois , Thaker Premal , Hu Wei , Urbauer Diana , Chisholm Gary , Sood Anil
Published: May 2017

INTRODUCTION:

Adrenergic stimulation promotes EOC growth and metastasis. Nonselective beta-blocker (BB) women with EOC is associated with longer OS. The purpose of this study was to determine the feasibility of beta-adrenergic blockade in women with EOC during initial chemotherapy in a prospective clinical trial.

METHODS:

Women with suspected diagnosis of EOC, primary peritoneal or fallopian tube cancer with plan for tumor reductive surgery (TRS) or neoadjuvant chemotherapy were eligible. Patients (pts) began propranolol 10-20 mg BID 48 hrs prior to any treatment. QOL and serum levels of angiogenic cytokines were assessed. Random effect Tobit models were used to determine association between response and IL6, IL8 and VEGF.

RESULTS:

32 pts enrolled, 6 ineligible leaving 26 for analysis. Of 26 pts, 8 did not complete 6 cycles on BB. Only 1 pt stopped due to fatigue after 4 days of BB. Eighteen pts (69%) completed all 6 cycles on BB; 69% were white. Mean age was 58; 80% were stage IIIC- IV, 30% were primarily debulked and 85% had optimal TRS. Serum IL 6, IL 8 and VEGF correlated with response (p < 0.0001). For 18 pts completing 6 cycles on BB, overall QOL, anxiety and depression improved significantly (p=.03).

CONCLUSION:

The impact of adrenergic stimulation on cancer growth is well documented and deserves further evaluation in a randomized setting. Use of propranolol during primary treatment of EOC, PP/FT cancer is feasible and potentially results in improved QOL.
Uterine Carcinosarcoma as a Cancer Cluster? [11J]
Authors: Williams Brittney , Ziebarth Angela , Burns James
Published: May 2017

INTRODUCTION:

Carcinosarcoma is a rare uterine malignancy. While the risks are similar to endometrial adenocarcinoma, it is more aggressive It accounts for approximately 4% of all uterine malignancies. The CDC defines cancer clusters as a geographic area with a greater than expected number of cancer case occurrences. There is limited data on uterine carcinosarcoma as a cancer cluster. The primary purpose of this review is to determine if there is a cancer cluster of uterine carcinosarcoma.

METHODS:

A retrospective chart review was performed. All patients with a pathologic diagnosis of carcinosarcoma in the Florida panhandle between 2008 to 2015 were reviewed. Patients were further identified based on uterine carcinosarcoma. Data collected included race, city and zip code, cancer stage at diagnosis.

RESULTS:

There were 31 patients diagnosed with uterine carcinosarcoma during this seven-year period. There were two geographic areas in which most of the patients 17 patients lived in the 4 main areas while 5 patients lived another 4 main areas in this region. In regards to race the majority of patients were Caucasian (20). Of the patients who were staged the majority were Stage 1 (8).

CONCLUSION:

Within a seven-year period, 31 patients with one type of rare cancer is a high number. Our patient population had more Caucasian patients. These two areas in the Florida Panhandle could represent a potential cancer cluster for uterine carcinosarcoma that could prove to provide new epidemiological data about this cancer. Further work to examine the geographical area and determine progression and overall survival are necessary.
Risk-Reducing Salpingo-Oophorectomy for BRCA Carriers: Is There a Benefit to Combination With Breast Surgery? [17J]
Authors: Liu Cici , Sims Travis , Kehoe Siobhan
Published: May 2017

INTRODUCTION:

Patients with BRCA mutations must decide whether and when to perform risk-reducing salpingo-oophorectomy (RRSO). The combination of RRSO with mastectomy and/or breast reconstructive surgery is an attractive option. We evaluate the postoperative complication rates of RRSO in combination with breast surgery compared to RRSO alone.

METHODS:

A retrospective chart review was performed to identify patients treated with RRSO for a BRCA mutation at our institutions from 2002 through August 2016. Statistical analysis was performed using unpaired student's t, Fisher’s exact and chi-square tests.

RESULTS:

Out of 127 patients, 44 had combined breast and RRSO surgery while 83 had RRSO alone. Median age, BMI, and comorbidities were similar for both groups. The frequency of hysterectomy was also comparable: 41% in the combined vs. 46% in the RRSO group. Patients undergoing combined surgery had significantly longer mean operative times (412 vs. 164 min), more blood loss (218 vs. 96 mL), and longer hospital stay (3 vs. 1.4 days). However, the overall postoperative complication rates were similar between the two groups. Although most gynecologic procedures were performed laparoscopically, the RRSO group had more robotic surgeries and the combined surgery group had more laparotomies.

CONCLUSION:

For women with a BRCA mutation, it is a feasible and reasonable option to undergo risk-reducing salpingo-oophorectomy at the time of breast surgery. Combined surgery is associated with longer operative time, more blood loss, and longer hospital stay, but this was not associated with worsened postoperative outcomes. Further research is warranted to evaluate patient satisfaction and the cost-effectiveness of combined surgeries.
Surrogates of Progression-Free Survival in Endometrial Cancer Patients: An Evaluation of Tissue Composition [19J]
Authors: Penick Emily , Tian Chunqiao , Wang Guisong , Maxwell George , Hamilton Chad , Darcy Kathleen
Published: May 2017

INTRODUCTION:

Endometrial cancer (EC) is a heterogeneous disease that varies in tumor composition. The goal of this study was to determine if the composition of endometrial tumors have potential prognostic value.

METHODS:

Tissue composition of frozen tumors and clinical outcome data were downloaded from the Cancer Genome Atlas (TCGA) Uterine Corpus Endometrial Carcinoma project. Tumors were scored by TCGA pathologists for percent tumor cellularity, necrosis, stromal cells, lymphocytes, monocytes, and neutrophils. The relationship between these measures of tissue composition and clinical outcome were evaluated using log-rank test and Cox modeling. Relationships with clinical characteristics were evaluated using Fisher exact testing.

RESULTS:

There were 547 evaluable EC patients, including 28% with advanced stage, 75% with endometrioid histology and 21% with serous cancers. Presence versus absence of necrosis, stromal cells, or neutrophils in the tumor samples was associated with worse progression-free survival (PFS) and an increased risk of disease progression (P < .05). The presence of necrosis in the research sample was also an independent surrogate of poor PFS in EC patients after adjustments for stage, cell type, grade and myometrial invasion (hazard ratio=1.56, P=.044). Necrosis was more common in patients with advanced stage (P=.012), higher grade (P < .0001), and deeper myometrial invasion (P < .0001).

CONCLUSION:

The presence versus absence of necrosis in EC tumors is a promising surrogate of poor versus good prognosis for EC patients with independent prognostic value after adjustment for stage, cell type and tumor grade.