bluuebunny/crossref_metadata_2025 huggingface dataset:
Association of Above-Average Healthy Eating Index and Pregnancy Outcomes [ID: 1375493]
Authors: Tuel Kierstyn , Hersh Alyssa , Purnell Jonathan , Ryan Kimberly , Valent Amy , Vesco Kimberly
Published: May 2023

INTRODUCTION:

Nutritional health plays an important role in the intrauterine environment's effect on the developmental origins of disease. The Healthy Eating Index (HEI), a measure of dietary quality scaled 0–100 with 100 being ideal, has been shown to be poor on average in Americans. In a prospective cohort study of healthy pregnant individuals with a singleton gestation, we assessed dietary quality and its association with pregnancy outcomes.

METHODS:

Individuals completed their first study visit at a mean gestational age of 15 weeks, and three, 24-hour dietary recalls were obtained. Participants were dichotomized by HEI scores as above and at or below the U.S. average (>58 and ≤58). We assessed outcomes including gestational diabetes (GDM), hypertensive disorders of pregnancy (HDP), and large for gestational age (LGA >90th percentile). Statistical analysis was completed using two-sample t tests and Fisher's exact tests (P=.05). The study was IRB approved.

RESULTS:

Of the 67 participants included in the analysis, 45 (67%) had above average and 22 (33%) had below average HEI scores. The incidence of HDP was significantly lower among individuals with higher dietary quality (22.8% versus 4.4%, P=.03). Although the rates of GDM were not different between the two groups (15.6% versus 9.1%, P=.71), the proportion of LGA infants trended lower in those with higher HEI (4% versus 22%, P=.19).

CONCLUSION:

Our data suggest that higher dietary quality may lead to improved pregnancy outcomes and support the potential role of the HEI for further exploring these relationships in future research.
Access and Barriers to Home Device Use in Pregnancy [ID: 1375585]
Authors: Azar Michelle , Maben-Feaster Rosalyn , Moniz Michelle , Pangori Andrea , Peahl Alex , Wu Justine
Published: May 2023

INTRODUCTION:

Virtual prenatal visits are promising for removing barriers to care; however, prior work suggests pregnant people who may benefit most might lack access to tools like home blood pressure (BP) monitors. We assessed drivers of pregnant patients' access to and use of home BP monitors.

METHODS:

We conducted an IRB-exempt cross-sectional survey of postpartum patients admitted for childbirth at an academic institution. After obtaining consent, we assessed patients' barriers to accessing home devices during pregnancy. Data were summarized using descriptive statistics and between-group comparisons.

RESULTS:

78/200 (39%) patients surveyed completed at least one virtual visit, of whom 76.92% were White and 23.08% were publicly insured. Patients who completed at least one virtual visit were more likely to report having a home BP monitor (73.08%) than those who had none (44.26%) (P<.001). More patients who had no virtual visits reported their provider did not recommend a BP monitor (41.80%) (P<.001), and not knowing how to check their BP (13.93%) (P=.048). Patients with public insurance (15.6%) and Black patients (17.4%) were more likely to report inability to obtain a BP monitor than commercially insured (4.5%) and White patients (3.1%) (P<.05).

CONCLUSION:

Access to BP monitors was limited in obstetrics patients who selected in-person care, were Black, and publicly insured. Policy change is needed to ensure patients who face the greatest barriers to care can access necessary tools for virtual visits.
Early Indicators That Universal Screening for Social Risk Factors Is Essential in the Perinatal Period [ID: 1381099]
Authors: Rogovin Hayley , Arem Hannah , Auguste Tamika , Laccay Christine , Patchen Loral , Thomas Angela
Published: May 2023

INTRODUCTION:

The District of Columbia has one of the highest maternal mortality rates in the United States. It is estimated that clinical factors account for 20% of health outcomes; the remaining 80% are attributable to other factors including social determinants of health (SDOH). This quality improvement project aims to examine the effectiveness of utilizing screening tools to identify social risk factors during the perinatal period.

METHODS:

We conducted a retrospective analysis of birthing individuals who completed our SDOH screening tool between April 1, 2021, and March 31, 2022. There were 1,106 birthing individuals screened. Social determinants of health were divided into seven risk categories: food insecurity, housing conditions, transportation, safety, legal, finance, and social support. Occurrences of each risk category were analyzed and compared for those who screened at both the pregnancy and postpartum stages.

RESULTS:

Of the 1,106 patients screened, 72% of the patients screened positive by reporting at least one social risk factor. Of those who screened positive, 81% requested general support. The primary needs identified were transportation (42%) and housing conditions (27%). Of 216 patients who were seen during pregnancy and postpartum, 24% had a decrease in the number of positive social risk categories from pregnancy to postpartum; 24% had the same; and 52% had an increase. There was a decrease in the number of patients with housing conditions; transportation needs increased.

CONCLUSION:

A majority of our perinatal patients report at least one social risk factor. The next step is to strengthen our ability to respond to resource needs identified by routine screening.
The Effect of Remdesivir on Liver Function Test Trends in Pregnant People With COVID-19 [ID: 1356660]
Authors: Kraus Alexandria , Kucirka Lauren , Sakai Nozomi , Weddendorf Elizabeth , Young Omar
Published: May 2023

INTRODUCTION:

The purpose of this study is to describe the effect of remdesivir on liver function test (LFT) trends when used in the treatment of COVID-19 in pregnant people.

METHODS:

This was a retrospective cohort study examining pregnant people with COVID-19 admitted to an academic medical center between October 1, 2020 and December 31, 2021. Patient data were obtained by querying the Data Warehouse for Health, a data repository sourced from the Epic EHR. Patient charts were reviewed to abstract missing data and to ensure accuracy of key variables. Demographics, clinical characteristics, and pregnancy outcomes were compared between those who received remdesivir and those who did not.

RESULTS:

The study cohort comprised 102 pregnant individuals, of whom 21 received remdesivir. Mean length of stay for patients who received remdesivir was 11.4 versus 4.2 days, and they were more likely to require intensive care unit admission (57.1% versus 2.5%) and intubation (9.5% versus 0%). Those who received remdesivir were more likely to deliver by cesarean section (62.5% versus 38.2%) and had a lower mean gestational age at delivery (35.5 weeks versus 37.8 weeks). Ten patients had a LFT doubling after treatment, and two were diagnosed with preterm preeclampsia. Patients with LFT doubling were more likely to be delivered by cesarean section (87.5% versus 16.8%) and had a lower mean gestational age at delivery (33.2 weeks versus 38.2 weeks).

CONCLUSION:

Thirty-three percent of patients treated with remdesivir had a doubling in LFTs. Two had increases attributed to preterm preeclampsia. Further research is essential to elucidate the autonomous effects of remdesivir, COVID-19, and preeclampsia, on liver function.
Obstetrical and Neonatal Outcomes in Women With Gestational Lyme Disease [ID: 1354384]
Authors: Courville Julien , Abenhaim Haim Arie , Czuzoj-Shulman Nicholas , Spence Andrea
Published: May 2023

INTRODUCTION:

The incidence of Lyme disease (LD) infections has risen in recent decades. Gestational LD has been associated with adverse pregnancy outcomes; however, the results have been contradictory. The objective of this study was to examine the effects of gestational LD on obstetrical and neonatal outcomes.

METHODS:

Using the Healthcare Cost and Utilization Project–National Inpatient Sample database from the United States, we conducted a retrospective cohort study of pregnant women who were admitted to hospital between 2016 and 2019. The exposed group consisted of pregnant women with gestational LD infection (ICD-10 code of A692x), whereas the comparison group consisted of pregnant women without gestational LD. Descriptive statistics and multivariate logistic regression models, adjusted for baseline maternal characteristics, were used to determine the associations between gestational LD and obstetrical and neonatal outcomes.

RESULTS:

Our cohort included 2,943,575 women, 226 of whom were diagnosed with LD during pregnancy. The overall incidence of gestational LD was 7.67 per 100,000 pregnancy admissions. The incidence of gestational LD was stable during the study period. Women with gestational LD were more likely to be Caucasian, older, have private health insurance, and earn higher incomes than the comparison group. Gestational LD was associated with an increased risk of placental abruption (adjusted odds ratio [aOR] 3.45, 95% CI 1.53–7.80) and preterm birth (aOR 1.58, 95% CI 1.03–2.42).

CONCLUSION:

Gestational LD is associated with a higher risk of placental abruption and preterm birth. Pregnancies complicated by LD may benefit from being closely monitored in tertiary care settings.
Fetal Gastroschisis: Does Fetal Growth Restriction Correlate With Small for Gestational Age at Birth? [ID: 1375594]
Authors: Brawley Amalia , Pauli Jaimey , Stetter Christy
Published: May 2023

INTRODUCTION:

Conflicting data exist regarding the optimal formula for calculating estimated fetal weight (EFW) in fetuses with gastroschisis. The widely used Hadlock formula includes abdominal circumference (AC) and may underestimate EFW, as fetuses with gastroschisis tend to have a smaller AC. We evaluated 1) correlation between EFW and birth weight (BW) and 2) agreement between fetal growth restriction (FGR) and small for gestational age (SGA) in fetuses/neonates with gastroschisis.

METHODS:

This was an IRB-approved single-center retrospective cohort study at a tertiary care center. Data were obtained from 2012 to 2021 and included singleton pregnancies with at least one growth ultrasound (US) performed by our center and neonate born at our center with confirmed gastroschisis. Pearson correlation was used to examine association between EFW and BW. Kappa statistic was used to examine agreement between FGR and SGA.

RESULTS:

Thirty-five maternal–neonatal pairs were included. There was a strong correlation between EFW on last growth US and BW (r=0.70, 95% CI [0.48, 0.84], P<.001). There was disagreement between FGR on last US and SGA at birth (Kappa coefficient=0.11, 95% CI [0.00, 0.22], P<.001) with 26 (74.3%) FGR fetuses, 5 (14.3%) of which were SGA neonates.

CONCLUSION:

Although EFW and BW were strongly correlated, less than one-fifth of fetuses diagnosed with FGR became neonates classified as SGA, suggesting that an EFW formula including AC overestimates FGR in fetuses with gastroschisis. Accurate estimation of EFW is necessary for antenatal testing, delivery planning, and avoiding unnecessary interventions. An alternative EFW formula could be considered for fetuses with gastroschisis.
Effect of SARS-CoV-2 Infection on Hypertensive Disease of Pregnancy [ID: 1381283]
Authors: Jessel Rebecca , Dubois Bethany , Janevic Teresa , Kaplowitz Elianna , Lesseur Corina , Mills Alexandra
Published: May 2023

INTRODUCTION:

Antenatal SARS-CoV-2 infection causes significant maternal morbidity and mortality. Preeclampsia and SARS-CoV-2 infection share common pathophysiology that may worsen pregnancy outcomes when both coexist. The purpose of this study was to investigate the effect of gestational SARS-CoV-2 infection on the risk of developing hypertensive disease of pregnancy (pregnancy-induced hypertension [PIH]).

METHODS:

We performed a study of 307 participants from the IRB-approved Generation C prospective cohort study in New York City designed to examine the effect of SARS-CoV-2 infection on maternal, fetal, and neonatal outcomes. SARS-CoV-2 infection during pregnancy was ascertained using a combination of PCR, spike and nucleocapsid IgG antibodies, and chart review. Maternal symptoms were assessed in the original Generation C study. Pregnancy-induced hypertension status was defined using the American College of Obstetricians and Gynecologists diagnostic criteria and excluded participants with chronic hypertension. Logistic regression was used to estimate associations between SARS-CoV-2 infection and PIH after adjusting for age, body mass index, race, history of diabetes including gestational, chronic hypertension, and history of PIH.

RESULTS:

Twenty-seven percent (n=84) of the 307 pregnant persons were infected with SARS-CoV-2 during pregnancy. No participants developed even moderate symptoms nor required hospitalization. Twelve percent (n=10) of those exposed developed any hypertensive disease of pregnancy. In participants without SARS-CoV-2 infection (n=223), 36 (16%) developed PIH. In adjusted multivariable models, gestational SARS-CoV-2 infection was not associated with PIH (odds ratio 0.53, 95% CI [0.22, 1.16], P=.13).

CONCLUSION:

Despite recent publications suggesting an increased risk of PIH in pregnancies complicated by antenatal SARS-CoV-2 infection, our study fails to reveal an increased risk of PIH associated with asymptomatic or mild infection in a diverse prospective New York City pregnant cohort.
COVID-19 Vaccination Coverage Among Pregnant Women by Race and Ethnicity: National Immunization Survey Adult COVID Module, United States, December 2020 to July 2022 [ID: 1375059]
Authors: Razzaghi Hilda , Black Carla , Hung Mei-Chuan , Jatlaoui Tara , Lu Peng-Jun , Srivastav Anup
Published: May 2023

INTRODUCTION:

Pregnant and postpartum women are at increased risk for severe illness from COVID-19.

METHODS:

Data from the National Immunization Survey Adult COVID Module collected April 22, 2021 to August 27, 2022, were analyzed to assess COVID-19 vaccinations (receipt of ≥1 dose) received from December 2020 to July 2022 among women aged 18–49 years who were pregnant at the time of the survey using Kaplan-Meier survival analysis. The NIS-ACM is a random-digit–dialed cellular telephone survey of adults aged 18 years or older. Data are weighted to represent the noninstitutionalized U.S. adult population and calibrated to state-level vaccine administration data.

RESULTS:

By the end of April 2021, national COVID-19 vaccination coverage was highest among Asian and non-Hispanic White (White) pregnant women (56.4% and 42.5%, respectively) and lower among multiple or other race (38.2%), Hispanic (34.5%), American Indian or Alaska Native (AI/AN) (34.3%), Native Hawaiian or other Pacific Islander (NH/OPI) (32.4%), and non-Hispanic Black (Black) (25.2%) pregnant women. By the end of July 2022, coverage had increased in all racial and ethnic groups and was highest among Asian (98.6%) and Hispanic (79.0%) pregnant women. Coverage was similar for multiple or other race (67.8%), White (66.2%), NH/OPI (64.6%), and Black (64.2%) pregnant women; however, coverage remained lower for AI/AN (49.1%) pregnant women.

CONCLUSION:

Although COVID-19 vaccination coverage among pregnant women has increased and racial and ethnic disparities have narrowed over time, approximately 1 in 3 remain unvaccinated. A strong recommendation for COVID-19 vaccination is critical for all women of reproductive age to increase coverage and help achieve vaccine equity.
Evaluation of a Youth-Led Intervention to Improve Adolescent Sexual and Reproductive Health Knowledge, Efficacy, and Autonomy [ID: 1377919]
Authors: Sao Saumya , Coleman Jenell , Izadi Lillee , Wang Runzhi , Yu Ruoxi
Published: May 2023

INTRODUCTION:

Youth bear a disproportionate burden of sexually transmitted infections (STIs) and unintended pregnancy. Knowledge about sexual and reproductive health (SRH) is low among this population, and youth face numerous barriers to care. We sought to develop and assess a youth-led intervention to increase youth SRH knowledge, self-efficacy, and autonomy, which are key indicators in developing positive sexual health behaviors and skills to feel confident in accessing health services.

METHODS:

Nine interactive, youth-led, 2-hour sessions were held virtually or in-person over 9 months. Session topics included human immunodeficiency virus and STIs, contraception, reproductive anatomy, menstrual health, healthy relationships, sexual decision-making, sexual violence, substance use, goal setting, gender identity and sexuality, and navigating health care services as an adolescent. Monetary compensation and transportation were provided. Sexual and reproductive health knowledge, self-efficacy, and autonomy were assessed using validated scales via an electronic questionnaire before and after implementing the intervention (IRB approved). Paired t tests were used to assess intervention effect.

RESULTS:

Thirty-seven participants with a mean age of 15.8 years (SD 1.13) were enrolled. All lived in the greater Baltimore area, and the majority self-identified as female. 52% were Black/African American, 28% Asian/Asian American, 12% White, and 8% Hispanic/Latino. Average attendance across sessions was 88%. Participants showed improvement in SRH knowledge (P=.02), advocacy and self-efficacy (P<.001), and personal safety and autonomy (P<.01). They reported increased comfort using trusted sites to procure SRH information (P<.01).

CONCLUSION:

A youth-led SRH intervention effectively increased SRH knowledge, self-efficacy, and autonomy. Further work should be done to explore the effects and expansion of peer-to-peer SRH education.
Developing an Obstetrics and Gynecology Residency Curriculum for the Care of Gender-Diverse Patients [ID: 1380351]
Authors: Lee Alice , Rajagopalan Supraja , Rowland Ayresleigh , Viloria Rebekah
Published: May 2023

INTRODUCTION:

Standardized training across obstetrics and gynecology residency programs to care for LGBTQIA+ and gender-diverse individuals is lacking. A pilot simulation session for ob-gyn residents was developed to educate, increase comfort, and assess clinical competency in providing reproductive and sexual health care for this population.

METHODS:

A simulation session with standardized patients was developed for ob-gyn residents at a university teaching hospital (n=16). The session focused on the gynecologic exam, counseling for gender-affirming therapies and surgeries, as well as contraception and family building options in this population. Presession and postsession surveys of knowledge, attitudes, and behaviors were analyzed. The initial simulation session was conducted in May 2021. After a repeat simulation in March 2023, 2 years of data will be included in the final analysis.

RESULTS:

Posttest attitude analyses demonstrated that among residents with lower pretest scores, the majority endorsed increased comfort with explaining and eliciting gender identity. All residents agreed or strongly agreed that the simulation was effective in improving their communication with transgender and gender-diverse patients, and similarly agreed or strongly agreed that they desired a similar training session in the future.

CONCLUSION:

Advancing sexual, reproductive, and gender-affirming care for LGBTQIA+ individuals requires institutional investment in standardized educational opportunities for ob-gyn residents. This initiative to develop a longitudinal patient simulation session for ob-gyn residents offers a unique and effective model for other residency programs.
Lessons Learned From the Integration of Reproductive Health Specialists in the Multidisciplinary Care of Women With Locally Advanced Breast Cancers [ID: 1347982]
Authors: Miller Madison , Bensenhaver Jessica , Cannella Cara , Petersen Lindsay , Swain Monique
Published: May 2023

INTRODUCTION:

The objective of this study was to investigate whether a multidisciplinary approach to breast cancer care with the inclusion of a reproductive health specialist improves referral rates for fertility counseling and/or preservation.

METHODS:

An IRB-approved retrospective study including women of reproductive age diagnosed with locally advanced breast cancer and treated at a health system before and after the advent of a comprehensive, multidisciplinary tumor board (cMTB) with a reproductive health specialist was conducted. Rates of referral for fertility counseling and utilization of fertility preservation methods were compared between the cMTB and non-cMTB groups using t tests. Secondary analyses comparing baseline group characteristics and rates of referral/fertility preservation by age, insurance type, and race were performed using χ2 tests.

RESULTS:

Of 306 study participants, 117 were cared for by a non-cMTB and 189 by a cMTB. The groups did not differ in average age, parity, breast cancer subtype, insurance type (public versus private), or treatment site (urban versus suburban); however, the distribution of race was significantly different (P=.003). Overall, a greater percentage of women in the cMTB group received referrals for fertility counseling compared to those in the non-cMTB group (23.3% versus 0.9%, P<.001). Of the patients in the cMTB group who were referred for counseling, 20.5% underwent fertility preservation. Within the cMTB group, women younger than 30 were significantly more likely to be referred for fertility counseling (41.7% versus 20.6%, P=.043) and undergo a fertility preservation procedure (16.7% versus 3.0%, P=.016) than those aged 31–40. No significant differences in rates of referral or fertility preservation by race or insurance type were noted within each group.

CONCLUSION:

The inclusion of a reproductive health specialist in a multidisciplinary breast cancer tumor board increased rates of referral for fertility counseling for women of reproductive age. A similar, comprehensive approach to the care of reproductive-aged women with gynecologic malignancies should be considered.
Does Bundling Matter? The Effect of Providing HPV Vaccination Before Tdap Vaccination on Timely Completion of the HPV Vaccine Series [ID: 1381348]
Authors: Kajtezovic Sidika , Fiascone Stephen , Morgan Jake , Perkins Rebecca
Published: May 2023

INTRODUCTION:

The American Academy of Pediatrics and American Cancer Society promote vaccine initiation at age 9 as one way to improve human papillomavirus (HPV) vaccination rates. Studies have noted increased HPV vaccine series completion rates when the series was begun before age 11. We used a national sample to assess the effect of initiating the HPV vaccine series initiation prior to the adolescent platform on timely series completion.

METHODS:

To explore the effect of initiating the HPV vaccine series prior to other vaccines in the adolescent platform (unbundling) on timely series completion, we created a cohort of children aged 9 in 2015 who were continuously enrolled through the age of 13 (2019) from a national administrative database of employee-sponsored insurance (MarketScan). Logistic regressions were used to predict the odds of HPV vaccine series completion among those who started the series prior to, concurrent with, or after receiving tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccination. The cohort included 100,857 eligible children.

RESULTS:

Compared with adolescents who received their HPV and Tdap vaccinations concurrently, those who received HPV prior to Tdap had higher completion (adjusted odds ratio [aOR], 1.38), whereas those who received their HPV vaccination after Tdap had lower odds of HPV vaccine series completion (aOR 0.68). Other factors associated with series completion included female sex, residing in an urban (versus rural) area, residing in the Northeast, and receiving primary care from a pediatrician (versus family medicine physician).

CONCLUSION:

These data indicate that beginning the HPV vaccine series prior to the adolescent platform (unbundling) may improve on-time series completion.
Integrating Obstetric Point-of-Care-Ultrasonography (POCUS) Simulation Curriculum [ID: 1363619]
Authors: Lee Emily , Rubio Xiomara Brioso , Chang Yifan , Crabtree Janice , Ding Jia Jennifer , Pathy Shefali
Published: May 2023

INTRODUCTION:

Point-of-care ultrasonography (POCUS) is increasingly used in medicine and is widely integrated into training. While obstetric (OB) ultrasound (US) is prevalent, its formal use and curriculum is often overlooked in POCUS training.

METHODS:

We performed a prospective comparative study of medical students who underwent formal obstetrics POCUS training and simulation. Students participated in a pre- and post-knowledge assessment of basic (presentation, placentation, fluid) and advanced (biometry and basic anatomy) knowledge. Scores were compared via Wilcoxon signed-ranks test. In addition to formal didactics, students participated in hands-on simulation training. The simulation provided one-on-one biometry training with a high-fidelity CIRS model 065-20 fetal model. Participants were evaluated on their ability to perform a complete fetal biometry.

RESULTS:

There were 58 participants in formal POCUS simulation training. Prior to training, only 29.7% were comfortable with a basic OB US and 8.1% were comfortable with performing biometry. Afterwards, 83.8% and 78.4% were comfortable performing basic and biometry US. Students had significantly higher basic OB US knowledge comparing before (Mdn=50.0) to after training (Mdn=83.3) (Z=5.27, P<.01). Similarly, there was a significant increase in advanced OB US knowledge comparing before (Mdn=56.3) to after (Mdn=100.0) (Z=4.99, P<.01). All participants were able to complete biometry measurements on the CIRS model. 91.9% of participants recommended this training to others.

CONCLUSION:

Obstetric ultrasound provides invaluable opportunity for learners to gain POCUS skills. Formal training and simulation significantly improves learning knowledge, confidence, and practical OB POCUS skills that can be used during clinical care.
Are There Video Characteristics That Improve the Accuracy and Quality of Ob-Gyn Procedural Videos? [ID: 1376966]
Authors: McIlvaine Jamie , Foncham Juanita , Francis Antonia , Kayaalp Emre
Published: May 2023

INTRODUCTION:

YouTube has emerged as a common resource used by ob-gyn residents to learn procedural skills. There has not been any research conducted that examines the relationship between video characteristics and the quality and accuracy of ob-gyn procedural videos. The purpose of this study was to assess whether YouTube video metrics, including number of likes, views, channel subscribers, geographic location, and organizational affiliations, can be used to gauge the quality and accuracy of ob-gyn procedural videos.

METHODS:

Using American College of Obstetricians and Gynecologists (ACOG) surgical curriculum topics, we conducted a search query into YouTube and sorted by relevance. Screening criteria were used to exclude videos. We then recorded video characteristics and scored the videos using the Laparoscopic Surgery Video Educational Guidelines (LAP-VEGaS) video assessment tool for quality. Additionally, we scored videos for accuracy by comparing them to the ACOG Surgical Curriculum in Obstetrics and Gynecology (SCOG) checklist.

RESULTS:

Of the 306 videos analyzed, number of likes, views, channel subscribers, and geographic location were not of high quality with LAP-VEGaS scores less than 11. The number of likes, views, and channel subscribers were not significantly associated with LAP-VEGaS or SCOG accuracy. There was a significant difference in LAP-VEGaS score and SCOG accuracy with international health care organization/specialty society with P values of .004 and .001, respectively.

CONCLUSION:

Of the characteristics studied, number of likes, views, and channel subscribers, and geographic location did not have a statistically significant difference in accuracy of educational value. Only association with international health care organizations/specialty societies was significantly associated with an increased LAP-VEGaS, indicating increased quality of video and increased percent accuracy by ACOG standards.
Provider Adherence to Edinburgh Postnatal Depression Screening [ID: 1375752]
Authors: Linfield Rachel , Marty Lindsay , Myrick Olivia
Published: May 2023

INTRODUCTION:

As part of a quality improvement initiative at a high-volume, outpatient obstetric center, a preintervention performance metric was obtained that determined physician adherence to providing the Edinburgh Postnatal Depression Screen (EPDS), which identifies patients with perinatal mood and anxiety disorders.

METHODS:

This was a retrospective chart review conducted over a 6-month period at the outpatient offices of an academic faculty group practice in a large, urban area. Provider adherence to EPDS screening and documentation was identified as per the standard office protocol—at both 24–28 weeks of gestation and 6–8 weeks postpartum. Patient population was limited to those who presented to their postpartum visit at the designated offices from January 2021 to June 2021 and received antenatal care through this same location.

RESULTS:

Four hundred forty-five patients met the inclusion criteria for receiving both antenatal and postpartum care within the selected time frame. Antenatally, only 55% of patients received a properly scored EPDS, 12% of patients were screened but the scores were not documented, and 33% of encounters did not include depression screening. Postpartum, only 60% of patients received a properly scored EPDS, 16% of patients were screened but the scores were not documented, and 24% of postpartum encounters did not include depression screening.

CONCLUSION:

This study emphasizes the need for increased physician education and targeted changes to workflow with respect to prioritizing depression screens for patients in antenatal and postpartum periods. Further trends will highlight the need for targeted education interventions or specific patient populations that require more attention to ensure screening is performed.
Study Participants' and Clinicians' Experiences With Placement of a Novel Low-Dose Copper Intrauterine Device With a Nitinol Frame in Nulliparous Versus Parous Participants [ID: 1374840]
Authors: Turok David , Hou Melody , McNicholas Colleen , Nelson Anita , Peters Kevin , Roe Andrea
Published: May 2023

INTRODUCTION:

Clinicians may perceive intrauterine device (IUD) placement to be more challenging for nulliparous versus parous users. This study assesses nulliparous versus parous study participants' and clinicians' experiences with placement of a novel, low-dose copper (175 mm2) IUD with a flexible nitinol frame.

METHODS:

This single-arm, IRB-approved, phase 3 clinical trial recruited pregnancy-capable people aged 17–45 at 42 U.S. centers. We compared nulliparous and parous participants' experiences for first IUD placement attempt including successful placement, participant-reported pain (on an 11-point numeric pain rating scale), investigator-reported ease of IUD placement (on a 5-point Likert scale), need for mechanical cervical dilation, and uterine perforation.

RESULTS:

Of 1,620 participants enrolled, 973 (60.1%) reported nulliparity and 647 (39.9%) parity. Successful IUD placement occurred at first attempt for 929 (96.0%) nulliparous versus 625 (96.6%) parous participants. Including second attempts, successful placement occurred for 1,601 (98.8%) participants. Nulliparous participants reported a mean pain score of 5.6 (±2.19) versus 4.0 (±2.55) for parous participants (P<.001), and investigators more frequently reported hard or very hard IUD placement in 81 (8.4%) nulliparous versus 22 (3.4%) parous participants (P<.001). Among nulliparous participants, 203 (21.2%) reported pain-related adverse events associated with placement versus 65 (10.1%) in parous participants (P<.001). Mechanical dilation was required for 202 (20.8%) nulliparous versus 79 (12.2%) parous participants (P<.001). Uterine perforation occurred in 1 nulliparous (0.10%) and 1 parous participant (0.15%).

CONCLUSION:

Despite experiencing more challenging IUD placements than parous participants, nulliparous trial participants experienced similar IUD placement success with this novel, low-dose copper IUD.
Postpartum Hemorrhage: Preterm Versus Term Pregnancies [ID: 1356883]
Authors: Whelan Anna , Ciomperlik Halie , Ghose Ipsita , Mendez-Figueroa Hector , Wagner Stephen , Wiley Rachel
Published: May 2023

INTRODUCTION:

Unlike neonatal morbidity with preterm birth (PTB; <37 weeks), maternal complications with PTB are infrequently reported. We aimed to assess the risk of postpartum hemorrhage (PPH)-related maternal morbidity among preterm versus term deliveries.

METHODS:

This was a secondary analysis of an IRB-approved retrospective cohort of all in-house singleton deliveries over 1 year. Demographics, pregnancy and delivery characteristics were abstracted from charts. Individuals who delivered preterm were compared to those who delivered at term (>37 weeks) for the primary outcome of composite maternal morbidity (CMM—blood loss >1,000 mL, uterotonic use, transfusion, uterine tamponade, surgical intervention, intensive care unit [ICU] admission, hysterectomy, and maternal death). Multivariable regression was performed to assess the adjusted relative risk (aRR) of preterm delivery on CMM with variables specified a priori.

RESULTS:

Of the 4,554 deliveries in our level 4 hospital, 4,514 (99%) met the inclusion criteria, with 1,062 (23%) delivering preterm. The overall CMM was 23.2%, with it being 30.4% in PTB and 21.0% in term births. Controlling for age, body mass index greater than 30 kg/m2, nulliparity, insurance status, race, smoking status, and cesarean delivery, preterm deliveries had a 42% higher rate of the CMM compared to term births (aRR 1.42: 95% CI, 1.27, 1.60). Transfusion, ICU admission, and hysterectomy were significantly more common among PTB than term.

CONCLUSION:

Preterm deliveries were associated with significantly higher rates of postpartum hemorrhagic CMM than those who delivered at term. Interventional trials are needed to decrease the hemorrhagic morbidity with PTB.
Evaluation of the Effect of Water-Based Lubricants on the Vaginal Microbiome of Premenopausal and Postmenopausal Women [ID: 1376703]
Authors: Krychman Michael , Hood Sarah , Palacios Santiago , Soe Jin
Published: May 2023

INTRODUCTION:

Over-the-counter personal lubricants are available to relieve intimate discomfort associated with vaginal dryness. However, little is known about how personal lubricants may affect the vulvovaginal microbiome.

METHODS:

The present study recruited 50 premenopausal and postmenopausal women with mild-to-moderate vaginal dryness and dyspareunia. Participants were randomized to one of five lubricant treatment groups (of ranging osmolality and pH), stratified to account for menopausal status, and instructed to use their assigned lubricant during vaginal intercourse at least once a week over a 4-week period. A total of four vaginal swabs were sampled per participant pre (“baseline”)- and post (“2 hours,” “24 hours,” and “4 weeks”)-lubricant application to assess bacterial and fungal microbiome diversity via 16S (V3-V4) and ITS1 rRNA sequencing, respectively. The 301x2 paired-end reads were preprocessed to remove nonbiological and poor-quality reads using the dada2 package in RStudio. Cleaned reads were converted into Amplicon Sequence Variants (ASV) and classified using the SILVA rRNA gene database for bacteria, and the UNITE database for fungi. ASV counts were normalized to relative abundance as a function of total number of ASV per sample.

RESULTS:

Nonparametric ordination methods and multivariate analysis of variance showed that repeated application of all lubricants tested, did not significantly alter the vaginal microbiome for up to 4 weeks after product application. Microbiome diversity and relative abundance differed significantly between premenopausal and postmenopausal women but remained unchanged before and after lubricant application.

CONCLUSION:

Overall, lubricant use was associated with maintenance of the vaginal microbiome, regardless of the participant's menopausal status.
A 20-Year Analysis Assessing the Competitiveness of Obstetrics and Gynecology Residency Programs and Medical School Applicants [ID: 1365966]
Authors: Michelotti Ali , Schenken Claire , Schenken Robert , Stansbury Nicholas , Treffalls Rebecca
Published: May 2023

INTRODUCTION:

The competitiveness of obstetrics and gynecology residency programs in the last two decades is not well described in the literature. As such, we aimed to assess the change in competitiveness of obstetrics and gynecology programs over a 20-year period using a normalized competitive index (NCI).

METHODS:

Obstetrics and gynecology match data was obtained from the National Resident Matching Program (NRMP) (2003–2022). Applicant metrics (USMLE scores, research output and experiences, and work and volunteer experiences) were obtained from the NRMP and the Association of American Medical Colleges (AAMC) (2007–2021). The competitive index (CI) was assessed using the average number of programs ranked per applicant divided by match rate each year. The NCI was normalized by dividing the yearly CI by averaged CI over 20 years. Data were analyzed using univariate analysis and linear regression.

RESULTS:

When comparing the two decades (2003–2012 versus 2013–2022), applicants (1,539±77 versus 1,902±46, P<.001), positions (1,173±10 versus 1,345±31, P<.001), and number of programs ranked per applicant (13±0.04 versus 15±0.02, P<.001) have increased. While the match rate did not significantly change from 2003 to 2022 (76±3 versus 71±1, P=.14), the NCI increased (R2=0.92, P<.001), indicating increased competitiveness. Applicant metrics increased over time, including step 1 scores (212±3 versus 229±1, P=.01), step 2 scores (232± 4 versus 245±1, P=.002), and research output (2.5±0.4 versus 5.0±0.3, P=.002).

CONCLUSION:

Despite an increase in obstetrics and gynecology applicants and applicant metrics, match rates remain unchanged. However, the competitiveness of programs has significantly increased, as demonstrated by the NCI. The NCI may be a useful metric for applicants to determine competitiveness in comparison to match rates.
Research Initiative Supporting Excellence at the University of Cincinnati (RISE-UC): A Program to Develop and Support Research-Active Faculty Members
Authors: Haworth Kevin J. , Niederhausen Kelly C. , Smith Eric P. , Sadayappan Sakthivel , Wess Yolanda , Rubinstein Jack , Schauer Daniel P. , Soleimani Manoocher , Rouan Gregory W. , Fichtenbaum Carl J.
Published: May 2023

A combination of forces have markedly increased challenges to research-active faculty achieving sustained success. This article describes how one department at the University of Cincinnati College of Medicine (UCCOM) implemented a strategic plan, the Research Initiative Supporting Excellence at the University of Cincinnati (RISE-UC), to promote the research activity of its research-active faculty, fiscal year (FY) 2011–FY 2021. RISE-UC was implemented and regularly updated to address evolving needs. RISE-UC supported faculty members pursuing research via fiscal and administrative services to grow a critical mass of investigators; establish a shared governance model; create pathways for developing physician–scientists; develop discrete and targeted internal research funding; establish an Academic Research Service (ARS) unit (as infrastructure to support research); enhance faculty member mentorship; and recognize, celebrate, and reward research success. RISE-UC was informed by shared governance and resulted in substantial increases in total size of the faculty and external funding. More than 50% of Physician-Scientist Training Program graduates are active researchers at UCCOM. The internal awards program realized a return on investment of ~16.4-fold, and total external direct cost research funds increased from ~$55,400,000 (FY 2015) to ~$114,500,000 (FY 2021). The ARS assisted in the submission of 57 grant proposals and provided services faculty members generally found very helpful or helpful. The peer-mentoring group for early-career faculty members resulted in 12 of 23 participants receiving major grant funding (≥ $100,000; spring 2017–spring 2021) from sources including National Institutes of Health awards, Department of Defense funding, Veterans Affairs funding, and foundation awards. Research recognition included ~$77,000/year in incentive payments to faculty members for grant submissions and grants awarded. RISE-UC is an example of a comprehensive approach to promote research faculty member success and may serve as a model for other institutions with similar aspirations.
Efficacy of immune checkpoint inhibition in metastatic uveal melanoma: a systematic review and meta-analysis
Authors: Pham James P. , On Lawrence , Ardolino Luke , Hurwitz Joshua , Salaun Helene , Sim Hao-Wen , Joshua Anthony M.
Published: May 2023

Introduction

Metastatic uveal melanoma (mUM) has historically been associated with short survival and limited effective treatments. Immune checkpoint inhibitors (ICIs) have been trialed in mUM; however, robust conclusions regarding their efficacy are difficult to draw given small study sizes and heterogeneous patient populations.

Methods

Five databases were searched using a combination of ‘ICI’ and ‘mUM’ headings, and data on patient demographics, objective response rate (ORR), overall survival (OS) and progression-free survival

(PFS) were extracted. Pooled ORR was calculated using a random effects model and the inverse variance method. Available Kaplan–Meier OS and PFS curves were used to construct summary OS and PFS plots, from which median values were derived.

Results

Pooled ORR was 9.2% overall (95% CI 7.2–11.8) [4.1% for anti-CTLA4 (95% CI 2.1–7.7), 7.1% for anti-PD(L)1 (95% CI 4.5–10.9) and 13.5% for anti-CTLA4 plus anti-PD1 (95% CI 10.0–18.0)]. Median OS was 11.5 months overall (95% CI 9.5–13.8) [8.0 months for anti-CTLA4 (95% CI 5.5–9.9), 11.7 months for anti-PD(L)1 (95% CI 9.0–14.0) and 16.0 months for ipilimumab plus anti-PD1 (95% CI 11.5–17.7) (P <0.001)]. Median PFS was 3.0 months overall (95% CI 2.9–3.1).

Discussion

ICIs have limited efficacy in mUM and a recommendation for their use must consider the balance of benefit and risk for individual patients if no other options are available. Further biomarker profiling studies may be helpful in assessing which patients will benefit from ICIs, in particular the addition of ipilimumab to anti-PD1 therapy.
Minority Student Perspectives of Barriers, Supports, and Christian Virtues in an Undergraduate Christian Nursing Program
Authors: Kunnen Katherine E. E. , Miller Katherine , Oh Yehyeon
Published: May 2023

Diversity and inclusion are critical priorities in nursing education programs. Literature has focused on minority student experiences of barriers and supports—but not through a Christian worldview. This qualitative study using a phenomenological-hermenuetic approach gave voice to the experiences of 15 self-identified minority student graduates from a Christian baccalaureate nursing program. Data analysis revealed opportunities for growth in providing a supportive climate within the program and how Christian virtues of hospitality, humility, and reconciliation can be employed to achieve this goal.
Stability of 10 Beta-Lactam Antibiotics in Human Plasma at Different Storage Conditions
Authors: Bahmany Soma , Ewoldt Tim M.J. , Abdulla Alan , Koch Birgit C.P.
Published: May 2023

Background:

Recently, several studies have assessed the effects of therapeutic drug monitoring of frequently prescribed beta-lactam antibiotics, for which they were quantified in human plasma samples. Beta-lactams are considered unstable, leading to extra challenges in quantification. Therefore, to ensure sample stability and minimize sample degradation before analysis, stability studies are crucial. This study investigated the stability of 10 frequently used beta-lactam antibiotics in human plasma at relevant storage conditions for clinical use.

Methods:

Amoxicillin, benzylpenicillin, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, flucloxacillin, imipenem, meropenem, and piperacillin were analyzed using ultraperformance convergence chromatography tandem mass spectrometry and liquid chromatography tandem mass spectrometry. Their short-term and long-term stabilities were investigated by measuring quality control samples at low and high concentrations against freshly prepared calibration standards. Measured concentrations at each time point were compared with the concentrations at T = 0. Antibiotics were considered stable if recovery results were between 85% and 115%.

Results:

Short-term stability results indicated ceftriaxone, cefuroxime, and meropenem to be stable up to 24 hours at room temperature. All evaluated antibiotics, except imipenem, were stable on ice in a cool box for 24 hours. Amoxicillin, benzylpenicillin, and piperacillin were stable for 24 hours at 4–6°C. Cefotaxime, ceftazidime, cefuroxime, and meropenem were stable at 4–6°C up to 72 hours. Ceftriaxone and flucloxacillin were stable for 1 week at 4–6°C. Long-term stability results showed that all antibiotics were stable up to 1 year at −80°C, except imipenem and piperacillin, which were stable for 6 months at −80°C.

Conclusions:

Plasma samples for amoxicillin, benzylpenicillin, cefotaxime, ceftazidime, flucloxacillin, and piperacillin may be stored for a maximum of 24 hours in a cool box. Refrigeration is suitable for plasma samples of amoxicillin, benzylpenicillin, meropenem, and piperacillin for up to 24 hours and cefotaxime, ceftriaxone, ceftazidime and cefuroxime for 72 hours. Plasma samples for imipenem should be frozen directly at −80°C. For long-term storage, plasma samples can be stored at −80°C for a maximum of 6 months for imipenem and piperacillin and 12 months for all other evaluated antibiotics.
Long-Term Corneal Refractive Power Changes Two Decades After Radial Keratotomy With Microperforations
Authors: Iwamoto Yuri , Koh Shizuka , Inoue Ryota , Soma Takeshi , Oie Yoshinori , Maeda Naoyuki , Nishida Kohji
Published: May 2023

We retrospectively examined corneal refractive power in three patients who had been followed up for more than 20 years after radial keratotomy (RK) with microperforations (MPs). All patients underwent RK in both eyes and were referred to our clinic because of postoperative decreased vision. MP was observed in five of the six eyes at the initial visit. The corneal refractive power of the anterior and posterior surfaces of the 6-mm-diameter cornea was examined using Fourier analysis based on corneal shape analysis using anterior segment optical coherence tomography. The spherical components decreased in all three cases. The asymmetry and higher-order irregularity components and fluctuations in corneal refractive power were markedly greater in the two cases with MP in both eyes. Fluctuations in corneal refractive power were observed at more than 20 years after RK with MP. Therefore, careful observation is necessary, even after a long-term postoperative follow-up period.