bluuebunny/crossref_metadata_2025 huggingface dataset:
976 QUALITY OF DISCHARGE SUMMARIES FROM A CARE OF THE ELDERLY WARD—A QUALITY IMPROVEMENT PROJECT
Authors: Bajwa R , Belludi G
Published: June 2022

Introduction

Deficits in transfer of information between secondary and primary care are common but can have significant impact on patient care and can often be dangerous as well. It’s hard to quantify the quality of a discharge summary but certain parameters can be reasonably used as its surrogate.

Method

After review of literature from multiple sources, we identified 6 key indicators to assess quality of discharge summaries for patients discharged from a Care of the Elderly ward. In round 1, we collected data from 129 discharge summaries created over a period of 12 months. After analysis of data, a plan including education of doctors, posters display in wards and emphasis on compliance in ward rounds and MDTs was implemented. Round 2 of the QIP was performed 4 months later and data was collected from 50 discharge summaries.

Results

Significant improvement in compliance seen in all areas assessed which include; 1. Main diagnosis during admission—improved from 93% to 100% 2. Mobility at discharge—Improved from 31% to 82% 3. Resuscitation status—improved from 6% to 86% 4. Medication changes during admission and their rationale—20% to 62% 5. Discharge destination—66% to 96% 6. Social care requirements e.g. package of care etc.—59% to 82%.

Conclusion

Plan implemented after round 1 has led to a significant improvement in quality of discharge summaries which consequently results better communication between secondary and primary care. This improvement especially surrounding medication changes translates into better continuity of care and patient safety.
990 ADVANCE CARE PLANS IN UK CARE HOME RESIDENTS: AN IMPLEMENTATION STUDY
Authors: Garden G , Usman A , Readman D , Storey L , Wilkinson L , Wilson G , Dening T , Gordon A , Gladman J
Published: June 2022

Introduction

Research shows delivery of advance care planning (ACP) in care homes is highly acceptable, increases the proportion of residents dying in their preferred place, and reduces hospital admissions. We examined whether implementation of a service delivering ACP to care homes in Lincoln (UK) realised the research outcomes in routine practice.

Method

Implementation of a service undertaking ACP in care homes was evaluated using routine data. Outcomes included proportion of care homes agreeing to participate; proportion of residents agreeing to put ACPs in place; characteristics of residents with and without ACPs, and place of death of those dying with or without ACPs. Effect on hospital admissions was examined comparing pre- and post-implementation admissions in participating homes.

Results

Fifteen (63%) of 24 eligible care homes participated. ACPs were prepared for 404/516 (78%) residents. Those with ACPs were older, frailer, more cognitively impaired, and malnourished than those without. For those with ACPs (384/404; 95%), care homes were the preferred place of death. 219/248 (88%) of residents with ACPs who died did so in their care home compared to 33/49 who died without ACPs (33/49, (67%) (relative risk 1.35, 95%CI 1.1–1.6, p < 0.01). In the 15 participating homes, there were 717 hospital admissions over 360 pre-intervention care home months (mean 2.11 admissions per care home month). In the post intervention phase, there were 789 admissions over 341 care home months (mean 2.29 admissions per care home month).

Conclusion

Most residents wished to have ACPs, which appeared to have influenced place of death. However, the population value of the service was limited because not all care homes participated. Hospital admissions were not reduced. Future work should aim to ensure services are universally available to residents, and to identify why reductions in hospital admissions seen in research studies may not be replicated in clinical practice.
991 COMPREHENSIVE GERIATRIC ASSESSMENT FOR BEGINNERS: AN EDUCATIONAL TOOL TO AID THE IDENTIFICATION OF FRAIL PATIENTS & IMPROVE CARE
Authors: Scarlett L , Bafadhel L
Published: June 2022

Introduction

COVID-19 heavily impacted the way in which medical education was and is delivered due to social distancing and concerns over safety. E learning is an increasingly important tool to use in being able to continue to educate our current and future doctors but there are significant gaps in the market with tools aimed at educating healthcare professionals regarding issues that affect the older person. This project aimed to compare 3 different learning tools to establish the minimum acceptable requirements for trainees to improve self-perceived competence in the assessment of an older person.

Method

Mixed method study comparing three types of educational resources in Comprehensive Geriatric assessment: low fidelity and high-fidelity e-learning modules and in person training. How do the interventions improve trainee’s confidence and knowledge of the CGA?

Results

Total number of participants n = 23. 39% had previously had some teaching on CGA and 61% had not. All three education interventions were well received by trainees and helped to increase their self perceived confidence in the assessment of an elderly patient and recognising signs of frailty in a patient presenting to the acute medical take. 83% of trainees would recommend the in person session, 100% would recommend both the high fidelity e-learning module and low fidelity e-learning modules.

Conclusion

This project showed that there are still significant gaps in the education of junior doctors regarding matters specific to an elderly population and there are limited electronic educational resources that aim to tackle this problem. The study showed the unilaterally trainees preferred the high-fidelity e-learning module to improve their confidence but still appreciated in person teaching where able due to increased enjoyment. As a result this high-fidelity module has been adapted for all healthcare staff and has been incorporated onto the trust’s online learning platform and has been received well.
998 IMPROVING COMMUNICATION ON MEDICAL WARD ROUNDS IN PATIENTS WITH LIMITED ENGLISH BY IMPLEMENTING MEDICAL COMMUNICATION CHARTS
Authors: D'Souza A , Canoso A , Smith L J
Published: June 2022

Aim

To improve communication on the medical ward round with patients with limited English through implementation of a medical communication chart.

Introduction

King’s College Hospital (KCH), London, is situated in Southwark in which 11% of households have no members that speak English as a first language, 4.1% of London’s population report they do not speak English well. Language barriers impair healthcare delivery including during daily ward rounds. This has been exacerbated by the need for PPE during the SARS-CoV2 pandemic. Effective communication between healthcare teams and patients is essential for high quality, patient-centred care. Communication tools commonly used include online, telephone and face-to-face translation services but these have limitations.

Method

Face-to-face patient questionnaires were conducted in the pre-QIP (baseline) group to assess communication on medical ward rounds. Medical communication charts were designed by adapting pre-existing aids commonly used by speech and language therapy. Charts were translated into commonly spoken languages among KCH inpatients. Patients with limited English were selected from both COVID-19 and non-Covid wards. Pre-intervention and post-intervention questionnaires were completed in three Plan–Do–Study–Act (PDSA) cycles.

Results

At baseline, patients agreed or strongly agreed that the ward round addressed physical symptoms (8/8), concerns or anxieties (7/8), ongoing needs (7/8). Only 2/8 doctors felt they could communicate effectively with patients. In PDSA 1, 4/5 patients reported high satisfaction in communicating physical symptoms, anxieties or concerns pre-intervention with 5/5 post-chart implementation. 5/5 patients reported high satisfaction in communicating ongoing needs pre-intervention but only 3/5 post-intervention. In PDSA 2, 2/5 patients reported increased satisfaction in communicating physical symptoms, concerns or anxieties with 4/4 doctors reporting improved satisfaction in communication in PDSA 2 and 2/3 doctors reporting higher satisfaction in communication in PDSA 3.

Conclusion

Medical communication charts can help in delivering high-quality, patient-centred care in multicultural and multilingual healthcare settings within the NHS.
1042 COMPARISON BETWEEN CAMRY AND JAMAR DYNAMOMETERS IN MEASURING HAND GRIP STRENGTH AMONG OLDER POST-ACUTE COVID-19 OUTPATIENTS
Authors: Tai M H , Wan S N , Engkasan J , Ong T
Published: June 2022

Introduction

Hand grip strength is a useful measure of muscle function. Many hand dynamometers that are less costly than the gold standard Jamar dynamometer are available but their use in clinical outpatient setting has yet to be validated. This study aimed to determine the inter-instrument reliability between Camry electronic and Jamar hydraulic dynamometers.

Method

A cross-sectional study was conducted on patients aged ≥65 years during their post COVID-19 follow up clinic visit. Hand grip strength was assessed using both Jamar and Camry dynamometers following standard protocol while information on participants’ demographics, health and COVID-19 hospitalizations were collected from hospital electronic medical records. Reliability between both devices was determined using intraclass correlation coefficient (ICC) and devices were compared based on subcategories of participants’ demographics and clinical characteristics.

Results

Ninety-three participants (mean age: 73 ± 6 years, 52.7% males) were recruited in this study. Average grip strength recorded with Jamar dynamometer (18.1 ± 7.4 kg) was higher than Camry dynamometer (19.5 ± 6.6 kg). Sub categorical comparison depicted no significant discrepancy between the devices discovered among male participants (p = 0.262), Malay participants (p = 0.243) and participants aged >70 years (p = 0.090). According to the diagnostic cut-off recommended by Asian Working Group for Sarcopenia (AWGS) 2019, similar number of participants had low grip strength using Jamar (n = 69, 74.2%) and Camry (n = 68, 73.2%) dynamometers. The odds of Camry detecting low grip strength was 0.946 times (95% CI: 0.493–1.817) as compared to Jamar dynamometer. Readings measured using both dynamometers were highly correlated to each other (r = 0.88) with ICC of 0.92, indicating an excellent inter-instrument reliability.

Conclusion

Comparable measures between Jamar and Camry hand dynamometers support the interchangeable use of the devices among older population. Hence, the alternative use of Camry dynamometer is appropriate for the outpatient setting.
1055 SIMPLE APPROACHES TO CHARACTERISING MULTIPLE LONG-TERM CONDITIONS (MULTIMORBIDITY) AND RATES OF HOSPITAL ADMISSION IN UK BIOBANK
Authors: Dodds R M , Bunn J G , Hillman S , Granic A , Murray J , Witham M D , Robinson S M , Cooper R ,   ADMISSION Research Collaborative, Sayer A A
Published: June 2022

Introduction

Multiple approaches are used to describe MLTC, including counts and indices (weighted counts). However, few studies have directly compared different approaches which would be helpful for the design of future MLTC studies. We therefore aimed to compare the prevalence of MLTC and association with emergency hospital admission characterised using different approaches within the same dataset.

Method

We used baseline data from 501,596 UK Biobank participants (age 37-73y) combined with linked hospital episode statistics to characterise MLTC using four approaches: count of body systems affected (CB); count of 43 conditions (CC); Byles index (BI); and Charlson comorbidity index (CCI). For each we performed survival analyses to test associations to a combined endpoint of first emergency admission or death over five years from baseline interview, adjusting for age and sex. We used Harrell’s C-index to compare the discriminant value of the four approaches for the combined endpoint.

Results

Prevalence of two or more positive responses (indicating the presence of MLTC) was 45% for CB, 33% for CC, 6% for BI and 2% for CCI. 95,812 (19%) participants had one or more emergency admission or died in the first five years. All four approaches were associated with greater rates of admission/death. For example, using CC, compared to those with zero conditions those with one had 1.42 (95% CI 1.39,1.45), those with two 1.94 (95% CI 1.90,1.98), and those with 3+ conditions had 3.11 (95% CI 3.05,3.17) times greater rates. The predictive value of the four approaches was modest (C-indices ranging from 0.60 to 0.63).

Conclusion

The counts classified a greater proportion of the sample as having MLTC than the indices, highlighting that prevalence estimates of MLTC may vary depending on the approach used. All approaches had strong statistical associations with admission, but only moderate ability to identify individual participants at risk.
A Canonical Neighborhood Theorem for Mean Curvature Flow in Higher Codimension
Authors: Naff Keaton
Published: June 2022

In dimensions $n \geq 5$, we prove a canonical neighborhood theorem for the mean curvature flow of compact $n$-dimensional submanifolds in $\mathbb {R}^N$ satisfying a pinching condition $|A|^2 < c|H|^2$ for $c = \min \{ \frac {3(n+1)}{2n(n+2)},\frac {1}{n-2}\}.$
Critical Even Unimodular Lattices in the Gaussian Core Model
Authors: Heimendahl Arne , Marafioti Aurelio , Thiemeyer Antonia , Vallentin Frank , Zimmermann Marc Christian
Published: June 2022

We consider even unimodular lattices that are critical for potential energy with respect to Gaussian potential functions in the manifold of lattices having point density $1$. All even unimodular lattices up to dimension $24$ are critical. We show how to determine the Morse index in these cases. While all these lattices are either local minima or saddle points, we find lattices in dimension $32$, which are local maxima. Also starting from dimension $32$ there are non-critical even unimodular lattices.
Hispanic Knowledge and Attitudes About Transgender Individuals [A327]
Authors: Ortiz-Ramos Kevin J. , Muns Sofía , Oliver Ariadna Ramírez , Morales Rivera Shadaira N. , García-Rivera Enid , Romaguera Josefina
Published: June 2022

INTRODUCTION:

Transgender individuals belong to one of the most stigmatized and discriminated groups in society. Despite the importance of this issue, few studies have been devoted to quantitatively examine knowledge and attitudes about transgender individuals. This study aimed to assess knowledge and attitudes about transgender individuals among Hispanic individuals living in Puerto Rico (HLPR) to help identify areas in need of educational interventions aimed at increasing knowledge and improving quality of life for those in the transgender community.

METHODS:

After institutional review board approval, a sample of HLPR were invited to complete a pre-tested self-administered online questionnaire aimed to address demographics, transgender knowledge, and attitudes. Responses were analyzed using STATA version 13 frequency analysis.

RESULTS:

To date, 413 participants have completed the questionnaire, of which 68.72% were female. Of the participants: 72.17% had at least a bachelor’s degree, 57.39% knew a transgender person, and 62.20% were exposed to transgender-related topics throughout their education. Most respondents correctly defined sex (67.7%), sexual orientation (88.1%), and gender identity (62.8%). Moreover, 74.27% of participants strongly agreed that transgender individuals bring great value to their communities, and are a valuable part of society, and 89.95% even reported they strongly agreed with welcoming transgender people in the workplace.

CONCLUSION:

Consistent with the literature, younger individuals with higher levels of education and sensitivity towards the transgender community were more willing to participate in the study, displaying high levels of knowledge about and positive attitudes toward transgender individuals. Future studies with a larger and more diverse sample should be done to minimize sampling bias.
Pregnancy Outcomes in Multifetal Gestation Who Underwent In-Vitro Fertilization (IVF) as Compared to Spontaneous Conceptions [A332]
Authors: Mandourah Samar , Badeghiesh Ahmad , Baghlaf Haitham , Dahan Michael H.
Published: June 2022

INTRODUCTION:

This study’s aim is to compare pregnancy outcomes in multifetal gestations that were conceived spontaneously compared to in vitro fertilization (IVF). Few population-based studies have addressed this topic.

METHODS:

This is a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database. Our study cohort included 90,552 multifetal gestations conceived spontaneously and 3,219 IVF conceptions, from 2008-2014, inclusively. Multivariate logistic regression analyses were performed comparing maternal and neonatal outcomes, while adjusting for confounding variables. Subject was conducted using ICD-9 codes 651.X and 76.1 for multifetal gestation and ICD-9 code 23.85 for IVF. Each pregnancy was included once.

RESULTS:

IVF multifetal gestations had increased risk of pregnancy induced hypertension (adjusted odds ratio [aOR]:1.31, 95% CI, 1.20–1.43), gestational hypertension (aOR: 1.21, 95% CI, 1.04–1.41), preeclampsia (aOR: 1.31, 95% CI, 1.19–1.45), gestational diabetes (aOR: 1.26, 95% CI, 1.13–1.41) and placenta previa (aOR: 1.7, 95% CI, 1.32–2.19). IVF delivery outcomes were more likely complicated by cesarean section (aOR: 1.21, 95% CI, 1.10–1.33), preterm premature rupture of membranes (aOR: 1.33, 95% CI, 1.16–1.52), chorioamnionitis (aOR: 1.71, 95% CI, 1.37–2.14), postpartum hemorrhage (aOR: 1.44, 95% CI, 1.26–1.63) and transfusions (aOR: 1.48, 95% CI, 1.26–1.74). IVF neonatal outcomes were more likely complicated by small for gestational age (aOR: 1.26, 95% CI, 1.12–1.41) and congenital anomalies (aOR: 1.82, 95% CI, 1.29–2.57). IVF was not found to increase risks of eclampsia, preterm delivery, operative vaginal delivery, hysterectomy, or intrauterine fetal demise.

CONCLUSION:

Women with IVF multifetal pregnancies were more likely to have complications, with risks increased 20% to 70%. The role of infertility versus the need for IVF and the type of IVF protocol used should be further evaluated.
Improving Postpartum Hemorrhage Outcomes With Team-Based Simulation of Operating Room Transfers [A339]
Authors: Levit Elizabeth , Marko Emily K.
Published: June 2022

INTRODUCTION:

Postpartum hemorrhage is an obstetric emergency where time and team preparedness are of critical importance. The study objective was to determine the effectiveness of team simulations on transferring patients with severe postpartum hemorrhage for operating room (OR) procedures to improve patient outcomes.

METHODS:

A prospective pre/post simulation study design was used to assess effectiveness of labor/delivery and OR personnel in the transfer and preparedness for patients with postpartum hemorrhage requiring operative management. An existing multidisciplinary simulation course was expanded to transfer of the manikin to the OR to improve team communication and preparedness. Institutional review board Exempt status was obtained. Outcomes were measured using participant knowledge tests and safety culture surveys, as well as team performance assessments and time. Clinical outcomes were tracked during the study period.

RESULTS:

Seventy-eight multidisciplinary personnel composing 13 teams participated in the two-year study. Pre/post participant improvement occurred in knowledge (pre 68.75%, post 92.65%, P< .0001), confidence (pre 2.05, post 1.43, P=.0005) and team performance (pre 72.5%, post 85.42%, P<.0001). Protocols for postpartum hemorrhage were adjusted because of team debriefings, resulting in improved efficiency and reduced time to transfer. During the study period patient transfusions and intensive care admissions decreased by over 50%.

CONCLUSION:

Simulation training significantly improved team performance during postpartum hemorrhages requiring OR procedures. Timely transfer and preparedness are essential during severe postpartum hemorrhage and may have contributed to the improved patient outcomes observed during the study period.
Uterocervical Angle as a Screening Tool to Predict Preterm Birth [A341]
Authors: Armstrong Lacey , Allen Joa , Woodham Padmashree
Published: June 2022

INTRODUCTION:

The objective of this study was to determine if a larger uterocervical angle measurement at the time of second trimester transvaginal ultrasound is a predictor of preterm birth in a predominantly African American population. The study took place in Macon, Georgia at Perinatal Associates associated with The Medical Center, Atrium Health Navicent and Mercer University School of Medicine.

METHODS:

This institutional review board‒approved retrospective cohort study included women with singleton gestations who had transvaginal ultrasounds performed at Perinatal Associates in Macon, Georgia for cervical length screening between 16 0/7 weeks – 23 6/7 weeks from July 1, 2015-June 30, 2016 and delivered at Atrium Health Navicent. The images were reviewed and the uterocervical angles were measured.

RESULTS:

A total of 230 women were included in this study. The rate of spontaneous preterm birth in this cohort was 12.2%; for delivery, 95 degrees and >105 degrees had no association with spontaneous preterm birth < 37 weeks. Cervical length < 25 mm was significantly associated with spontaneous preterm birth.

CONCLUSION:

A uterocervical angle of >95 and >105 degrees detected during the second trimester transvaginal ultrasound was not associated with an increased risk for spontaneous preterm birth. Cervical length was a better predictor of preterm birth in this cohort. Our data indicates that uterocervical angle is not a useful tool in predicting preterm birth in a predominantly African American population and that traditional measurement of cervical length is a better screening tool.
Sensitivity of Broadened Definition of Fetal Growth Restriction in Predicting Adverse Neonatal Outcomes [A342]
Authors: Allen Stephanie M. , Contag Stephen A. , Rubin Nathan T. , Engel Melissa S.
Published: June 2022

INTRODUCTION:

In 2020 the Society for Maternal-Fetal Medicine suggested broadening the fetal growth restriction (FGR) definition to include fetuses with isolated abdominal circumference (AC) less than 10th percentile. The purpose of this study was to determine if including these fetuses improves prediction of severe neonatal morbidity and mortality.

METHODS:

This is a retrospective analysis of births over the past 10 years within a hospital system affiliated with the University of Minnesota. A pregnancy was included if prenatal ultrasound data were available after 24 weeks gestation. Excluded were non-singletons and fetuses with diagnosis of structural or genetic abnormalities that could affect biometry measurements. Fetuses were categorized as FGR based on the prior definition (estimated fetal weight [EFW] less than 10th percentile) and on the proposed definition of EFW or AC less than 10th percentile. Institutional review board approval was obtained from the University of Minnesota (ID 00011238).

RESULTS:

A total of 26,526 births met inclusion criteria. The mean gestational age at birth was 39 weeks (SD 0.2). The rate of severe morbidity (e.g., severe acidosis, hypoxic ischemic encephalopathy, and sepsis) and mortality for those with EFW less than 10th percentile was 9.3% (odds ratio [OR] 3.6, P<.001) and 2.8% (OR 26.1, P<.001), respectively. For those with EFW or AC less than 10th percentile, rates were 6% (OR 2.3, P<.001) and 1.5% (OR 15.0, P<.001), respectively.

CONCLUSION:

Broadening the definition unsurprisingly increased the frequency of FGR, but frequency of adverse outcomes was lower. Thus, this analysis does not support the addition of isolated AC less than 10th percentile to the FGR definition.
Provider Counseling Regarding Postmenopausal Bleeding [A297]
Authors: Wise Meredith , Schefter Alexandra M. , Bharucha Kharmen , Brill Joshua , Tessier Katelyn M. , Terrell Carrie A.
Published: June 2022

INTRODUCTION:

The aim of this study was to determine the rate of anticipatory counseling regarding postmenopausal bleeding (PMB) provided by obstetrician–gynecologists (ob-gyns) and primary care providers (PCPs). We also sought to determine whether counseling is associated with an increased likelihood of presenting for evaluation of PMB.

METHODS:

This survey study was administered at the University of Minnesota's research building at the Minnesota State Fair 2021. Eligible participants were aged 18 and older and female sex assigned at birth. Self-reported menopausal participants answered questions about their healthcare providers (PCP, ob-gyn, or both), when they were last seen, and whether they had been counseled about PMB. They were then questioned about when they would present to a provider for PMB.

RESULTS:

A total of 129 post-menopausal survey participants were included in the analysis. Of these participants, 46.5% (60 participants) reported that their provider counseled them about PMB. There was almost a significant difference between type of provider seen and rate of counseling, with the highest rate occurring in those who had seen both a PCP and an ob-gyn provider in the last 5 years (P=.052). A total of 61% of participants (79 participants) reported they would tell their doctor if they had PMB after just one episode. There were no differences in likelihood of telling a doctor about PMB between participants who had received counseling and those who had not.

CONCLUSION:

This study demonstrates a low rate of provider counseling regarding PMB. The relatively low likelihood of presenting for evaluation of an episode of PMB highlights the need for improved patient education regarding this symptom.
Disparities in Outcomes Following Ovarian Cancer: An Analysis of the Surveillance, Epidemiology, and End Results (SEER) Database (1998-2016) [A313]
Authors: Akinyemi Oluwasegun A. , Lipscombe Christina A. , Nasef Kindha Elleissy , Aaron Sabrina , Ranjit Anju
Published: June 2022

INTRODUCTION:

Ovarian cancer is the most lethal cancer among women in the United States. However, there are significant racial disparities in the timely diagnosis and treatment of ovarian cancers. It remains unknown if race is an independent predictor of adverse outcomes following treatment of ovarian cancer. The aim of this study is to determine if race is an independent predictor of adverse outcomes following diagnosis of primary ovarian cancer.

METHODS:

We utilized the Surveillance, Epidemiology, and End Results (SEER) 18 Registry to extract all patients with a primary diagnosis of ovarian cancer from 1998 to 2016. Our primary outcomes of interest were differences in mortality and survival (in months) among African American and White women. Propensity score matching was used to match the groups according to age, treatment modalities (surgery/irradiation/chemotherapy), laterality, and stage of cancer at presentation.

RESULTS:

We compared 6,801 African American and 27,204 White patients with primary ovarian cancer. Prior to propensity score matching, African American women had a higher mortality rate (56.7% vs. 53.5%; P<.001) and a lower survival rate (40.1 vs. 48.9 months; P<.001). Following propensity score matching, there was no difference in the mortality rate between the two groups (56.7% vs. 55.7%; P=.13). However, African American patients had significantly lower survival rates (40.1 vs. 49.6 months; P<.001).

CONCLUSION:

Racial disparities in survival following treatment for ovarian cancer persist despite adjusting for age, stage of cancer, and treatment modalities. Further research is warranted to explore patient and systemic factors such as appropriate level of care and follow up after treatment that might account for these differences.
Association Between External Cephalic Version and Body Mass Index For Nonvertex Presentation [A266]
Authors: Prewitt Kristin , Hersh Alyssa R. , Fennimore Nicole , Bullard Kimberley , Boniface Emily , Valent Amy
Published: June 2022

INTRODUCTION:

External cephalic versions (ECVs) are critical to preventing the primary cesarean section. We sought to assess the association between indication for ECV and pre-pregnancy BMI. We defined indicated for ECV by those who either had a non-cephalic presentation at delivery or had undergone ECV during pregnancy.

METHODS:

We conducted a retrospective cohort study using 2014–2018 National Vital Statistics Birth Data. Inclusion criteria were singleton, non-anomalous, >36 weeks gestation deliveries without prior cesarean. Those with missing data for BMI, delivery presentation, or ECV performed were excluded. We assessed rates of ECVs performed based on pre-pregnancy BMI categories (underweight, normal, overweight, and obese). Chi-square and multivariable logistic regression were performed for statistical analyses. We adjusted for age, race, ethnicity, and parity as confounders. All analyses were conducted using STATA version 17.

RESULTS:

Of the 549,422 patients included, 8.0% underwent an ECV. When assessed by BMI category, 7.6% in the underweight category, 8.6% in the normal category, 7.9% in the overweight category, and 7.2% in the obese category underwent indicated ECV. After adjusting for confounders, compared to normal weight patients, the odds of undergoing indicated ECV were 0.89 (0.84–0.94) for underweight patients, 0.91 (0.89–0.93) for overweight patients, and 0.81 (0.79–0.83) for obese patients.

CONCLUSION:

We found that the majority of patients eligible for ECV did not undergo ECV. The rates of attempted ECV are lower for patients with abnormal BMI. Future studies should assess the differences in rates of ECV by BMI and harms of primary cesarean section in these patients.
Evaluating the Importance of Immediate Postpartum Depression Screening [A269]
Authors: Zafman Kelly , Riegel Melissa , Wu Jessica , Leitner Kirstin , Srinivas Sindhu
Published: June 2022

INTRODUCTION:

Postpartum depression (PPD) is costly for women, families, and the health care system. Early identification is critical. We sought to evaluate PPD screening at delivery discharge and compare ongoing rates of positive screening among women at risk of PPD.

METHODS:

In September 2020, we implemented universal Edinburgh Postpartum Depression Scale (EPDS) screening postpartum (PP) prior to discharge. A score of 9–12 and>12 was moderate and high risk for PPD, respectively. All who scored≥9 met with social workers and were referred for outpatient resources. From September to December 2020, women who scored≥9 were contacted for re-screening at 1–3 weeks PP and at 6-weeks PP visit.

RESULTS:

A total of 1,256 women underwent immediate PPD screening. Of those, 165 (13.1%) scored ≥9, with 63 (5.0%) of these scoring >12. Two percent (n=24) indicated thoughts of self-harm. Over 50% (n=80) had no prior history of mental illness. Among women who scored≥9 immediately PP and were reached for re-screening, 58 of 111 (52.5%) scored ≥9 within 3 weeks and 48 of 93 (51.6%) scored ≥9 at their PP visit. Among women who scored>12 immediately PP, 32 of 42 (76.2%) scored ≥9 at 3 weeks and 24 of 31 (77.4%) scored ≥9 at their PP visit. Only 41 (24.8%) had initiated therapy by their PP visit.

CONCLUSION:

Immediate PP EPDS screening is feasible and captures women at risk of PPD. More than half of women who had an elevated score immediately PP continued to score high at their PP visit. Timely screening and access to mental health services is critical and should be integrated into PP care.
Does Insurance Status Effect the Nulliparous, Term, Singleton, Vertex Cesarean Delivery Rate? [A276]
Authors: Sigdel Manisha , Jiang Judy , Seidor Samantha , Benito Carlos W.
Published: June 2022

INTRODUCTION:

Per the CDC, nulliparous, term, singleton, vertex (NTSV) cesarean delivery (CD) rates are between 21% and 33% in the United States, and the current initiative is to decrease the NTSV CD rate to 24.7% by 2030. At Saint Peters University Hospital in New Brunswick, NJ, the NTSV CD rate was 29.3% in 2020.

METHODS:

This is a retrospective cohort study of NTSV patients who delivered between 1/1/2020 and 12/31/20. Data were obtained from Paragon Electronic Medical Record. The insurance status of each patient was obtained and codified as private insurance (PI) versus HMO, Medicaid, or no insurance/self-pay (NI) coverage. The mode of delivery and insurance type were recorded. NI patients are delivered by hospital-employed physicians present in the labor and delivery department, which is staffed 24 hours a day. Significance was set at P<.05.

RESULTS:

A total of 1,421 NTSV patients were delivered in 2020, with 1,004 delivering vaginally and 417 delivering via CD. There were 1,047 patients with private insurance, with an NTSV CD rate of 31% (325 of 1,047). There were 374 patients with NI, with an NTSV CD rate of 24.6% (92 of 374). There was a significant difference between the two CD rates (P<.0196).

CONCLUSION:

Patients with NI had a statistically lower CD rate (24.6% vs. 31.0%) as compared to those with PI. This may partly be due to the availability of hospital faculty physicians present in the hospital 24/7. The effect of individual practice patterns impacting the private NTSV CD rate cannot be ruled out. The majority of the private physicians are not present in labor and delivery 24 hours a day.
Tracheal Intubation in Term Infants—Trends, Risk Factors, and Outcomes: A Population-Based Study [A281]
Authors: Debay Anthony , Beltempo Marc , Czuzoj-Shulman Nicholas , Abenhaim Haim A.
Published: June 2022

INTRODUCTION:

Tracheal intubation (TI) is associated with hypoxia and an increase in intracranial pressure, potentially leading to brain injury. We aimed to estimate trends, risk factors, and outcomes among term neonates undergoing TI, using a large population-based database.

METHODS:

This is a retrospective cohort study of 2,122,245 births using the Healthcare Cost and Utilization Project/Nationwide Inpatient Sample from 2015 to 2018. Term infants having undergone TI were identified using ICD-10 codes. Infants with congenital anomalies were excluded. Multivariate logistic regression models were used to evaluate outcomes while adjusting for confounders.

RESULTS:

Rate of death was 4.4% among the 13,205 infants who had TI, and 0.04% among the 2,109,040 infants who did not have TI. Infants undergoing TI in urban teaching hospitals had higher odds of death compared to infants in rural hospitals (OR 1.77, 95% CI 1.17–2.69). Infants who had TI and died had higher odds of intraventricular hemorrhage (IVH; OR 5.28, 95% CI 4.08–6.83), hypoxic-ischemic encephalopathy (HIE; OR 2.34, 95% CI 1.86–2.94), and sepsis (OR 1.50, 95% CI 1.23–1.83); pulmonary hemorrhage (PH) was the greatest predictor of death (OR 7.34, 95% CI 5.17–10.42). Among infants who had TI and survived, odds of IVH (OR 76.24, 95% CI 67.33–86.32), HIE (OR 291.86, 95% CI 263.26–323.56), sepsis (OR 28.76, 95% CI 27.39–30.31), and PH (OR 542.01, 95% CI 384.73–763.58) were higher compared to controls.

CONCLUSION:

Term infants undergoing TI have higher mortality rates compared to controls; TI survivors have an increased risk of neurological sequelae. Non-invasive respiratory support and postnatal neuroprotective interventions should be optimized in term infants.
Assessing Clinical Outcomes of Uncomplicated Cystitis Treatment via Asynchronous Telemedicine [A121]
Authors: Martinez Melina , Newman Jesse , Dai Jiaxin , Nguyen Hoa , Jacobson Mary T.
Published: June 2022

INTRODUCTION:

Asynchronous telemedicine provides affordable, convenient, and accessible care for patients. An increase in telemedicine visits during the COVID-19 pandemic highlights the importance of assessing clinical outcomes in telemedicine. To our knowledge, this is the first study to examine treatment outcomes of cystitis in women via a telemedicine platform.

METHODS:

The objective of this retrospective study was to assess clinical outcomes and the appropriateness of treatment for uncomplicated cystitis in female patients utilizing an asynchronous telemedicine platform. Electronic medical records were retrospectively reviewed to collect data from patients seen via a direct-to-consumer telemedicine platform in the United States between June 2020 and August 2021. IDSA guidelines were used to determine the appropriateness of treatment. Reported adverse events were also gathered to assess safety.

RESULTS:

Data from 1,799 patients were included, with an average age of 29 (range, 18–84) years. Of these, 91% (1,646) of patients received IDSA guideline-recommended treatment, with 97% (1,747) experiencing symptom resolution and 3% (52) returning within seven days of their initial visit for additional concerns. The referral rate for additional in-person care or labs was 2% (43). In total, 1% (18) of patients experienced an adverse event.

CONCLUSION:

Patients utilizing an asynchronous telemedicine platform for the treatment of uncomplicated cystitis experienced high rates of symptom resolution and low rates of referral. Additionally, s prescribed guideline-concordant care. These findings support asynchronous telemedicine as a safe and effective option for the treatment of uncomplicated cystitis.
Racial and Ethnic Disparities in Menopausal Hormone Therapy Acceptance [A134]
Authors: Pershad Anita , Morris Joshua , Khanna Pallavi
Published: June 2022

INTRODUCTION:

There is a paucity of data on race and ethnicity in hormone therapy (HT) acceptance in previous menopause treatment studies. Our primary objective was to examine differences in HT acceptance between self-reported race and ethnic groups. Our secondary objective was to assess patient comorbidities and trends in reported symptom frequency at presentation in a menopause-focused care clinic.

METHODS:

Retrospective medical record review of patients presenting to a single menopause clinic from July 2018 to July 2021 at a tertiary level, urban, academic center in the Midsouth. Statistical tests included t test and odds ratios, with P values <.05 considered significant.

RESULTS:

A total of 113 patients presented with menopausal symptoms and were included; 58 (52%) were Black, 47 (42%) were White, and 8 (6%) declined to answer. Of 42 women with vasomotor symptoms, 23 (55%) accepted lifestyle modification therapy and 19 (45%) accepted HT. Of 34 women with vaginal dryness, only 5 (15%) accepted vaginal HT, while 29 (85%) accepted moisturizers/lubricants. A total of 20 patients were excluded from eligibility for systemic HT due to medical comorbidities. Of 37 women eligible for systemic HT, 18 (49%) of White women accepted HT, compared to only 9 (24%) of Black women. This difference was statistically significant (P=.01). Black women were 24% less likely to accept HT for menopausal symptom management (OR, 0.24; 95% CI, 0.09–0.64).

CONCLUSION:

Our pilot study suggests racial disparity in acceptance of HT among perimenopausal and postmenopausal women. This can inform clinicians about patient factors affecting treatment choice for menopausal symptoms and opportunities to explore racial differences in quality of care.
Assessment of In-Hospital Pain Control After Childbirth and Its Correlation With Anxiety in the Postpartum Period [A150]
Authors: Olson Clara , Poehlmann John , Stowe Zachary , Antony Kathleen M.
Published: June 2022

INTRODUCTION:

The relationship between pain and anxiety in medical and surgical contexts is established; less is known about this relationship in obstetric populations. This study evaluated whether there is an association between postpartum pain and anxiety.

METHODS:

In this institutional review board‒approved survey-based prospective cohort study, the General Anxiety Disorder-7 (GAD-7) and American Pain Society-Patient Outcome Questionnaire (APS-POQ) were completed the day of postpartum discharge. The association between moderate-to-severe anxiety and measures of pain control were assessed.

RESULTS:

A total of 64 subjects completed discharge surveys. Parturients with moderate-to-severe scores (≥10) on the GAD-7 also had more maximum pain scores (0–10 scale) in the severe range (≥7) in the first (P=.049) and second (P=.010) 24-hour periods after delivery and were more likely to have spent a higher percentage of their time in severe pain within these time frames (P=0.007 and P=0.010, respectively). Similar relationships were observed when classifying anxiety as no anxiety (GAD-7 score <5), mild anxiety (GAD-7 score 5–9), moderate anxiety (GAD-7 score 10–14), and severe anxiety (GAD-7 score ≥15). Parturients with preexisting anxiety did not have higher rates of perceived inadequate pain control. Parturients whose infants had health concerns did not have higher rates of anxiety.

CONCLUSION:

Postpartum pain levels were associated with higher levels of anxiety in the immediate postpartum period. Consideration of the relationship between pain control and anxiety may help optimize patients’ postpartum experience.
Intrahepatic Cholestasis of Pregnancy: Is Cholecystectomy a Risk Factor? [A168]
Authors: Collins Ana M. , Davidov Adi , Fruhman Gary
Published: June 2022

INTRODUCTION:

To evaluate the incidence of intrahepatic cholestasis of pregnancy (ICP) and determine if cholecystectomy is a risk factor for ICP.

METHODS:

We conducted a retrospective cohort study of women who delivered at SIUH from January 1, 2018, to December 31, 2020. During this timeframe, there were 8,025 deliveries. Exclusion criteria included intrauterine fetal demise (IUFD) and gestational age at delivery <24 weeks, maternal age <18 years, multiple gestations, and missing variables. After exclusion criteria, 7,146 deliveries were included in this study. We conducted analyses using Chi-square and t-tests, where P<.05 was considered statistically significant. The study was institutional review board‒approved.

RESULTS:

The overall incidence of ICP was 0.39%, which is consistent with the current estimated incidence in the U.S. The incidence of ICP in patients who had a prior cholecystectomy was 10.7%, compared with 0.17% in patients with no history of cholecystectomy (P<.001). The relative risk of developing ICP in patients with a prior cholecystectomy compared to those without cholecystectomy was 62.2 with a 95% CI of 29.9‒129.1 (P<.001). Patients with a prior cholecystectomy had higher bile acids and liver enzymes; however, only the difference in bile acids was statistically significant.

CONCLUSION:

There was an increased incidence and relative risk of developing ICP in patients with a prior cholecystectomy. As ICP can be associated with an increased risk of morbidity and stillbirth, providers should consider utilizing a lower threshold to screen for ICP in patients who have had a cholecystectomy. However, further studies are necessary to confirm these findings.
Factors Affecting Diagnostic Accuracy of Spot Protein/Creatinine Ratio for Evaluation of Proteinuria in Pregnancy [A171]
Authors: Khan Sameer A. , Burdeaux Shayna , Gurram Padmalatha , Polavarapu Satya , Sampino Anthony
Published: June 2022

INTRODUCTION:

Spot urinary protein/creatinine ratio (SPCR) has been shown to be a reliable alternative to 24-hour urine protein collection (24hrUP). Several factors can affect urine protein excretion. We aimed to study factors affecting diagnostic accuracy of SPCR in evaluating proteinuria.

METHODS:

Retrospective study of women who had 24hrUP and SPCR from July 2019 to May 2021. Correlation between SPCR and 24hrUP, clinical characteristics, inpatient versus outpatient collection, time of day were studied to determine any impact on accuracy of SPCR. Institutional review board‒approval was obtained.

RESULTS:

A total of 121 patients were included. Correlation between SPCR and 24hrUP was high (r=0.80). When stratified based on SPCR of >0.3 versus <0.3, 24hrUP and SPCR values were in agreement in 92 patients and non-agreement in 29 patients. Of those 29, 19 patients had elevated 24hrUP and normal SPCR and 10 patients had elevated SPCR and normal 24hrUP. The optimal cutoff appears to be SPCR of 0.3, with a sensitivity of 72% and specificity of 82%. Maternal age <35 years and inpatient collection tend to have higher false positive rates (P>.05). Tests performed from 6 p.m. to 11.59 p.m. had the highest false negative rates (FNR, P=.09). Patients with antepartum complications tended to have higher FNR (P≥0.05).

CONCLUSION:

This study suggests that when SPCR is >0.3, 24hrUP is not needed, but when SPCR is <0.3, 24hrUP is warranted. In women with antepartum complications, a lower cutoff might improve the correlation; further studies are required.
Recent Trends in NICU Admission Among Women With Gestational Diabetes by Race and Ethnicity [A172]
Authors: Mester Nonda , Pawar Deepraj , Hersh Alyssa R. , Boniface Emily , Valent Amy
Published: June 2022

INTRODUCTION:

To determine if NICU admission rates are increasing among neonates born to women with gestational diabetes and if there are disparities by race and ethnicity.

METHODS:

This was a retrospective cohort study of deliveries between 2014 and 2018 in the United States. Inclusion criteria were non-anomalous, singleton deliveries with gestational age ≥20 weeks and gestational diabetes. Analyses were stratified by maternal race/ethnicity, including the following categories: non-Hispanic (NH) White, NH Black, NH American Indian or Alaska Native (AI/AN), NH Asian or Native Hawaiian and Pacific Islander (NHOPI), NH multiracial and Hispanic. The confounders assessed included age, parity, cigarette use, educational attainment, gestational age at delivery, birth weight, and insurance type. We used multivariable logistic regression and calculated predicted probabilities (PP) to estimate the adjusted proportion of deliveries resulting in NICU admission. All analyses were conducted using STATA 17.

RESULTS:

There were 1,104,082 deliveries included in this analysis. The predicted probability of NICU admission was higher in 2018 than in 2014 for NH White, NH Black, and Hispanic women, but the results were not statistically significant. The predicted probability was lower in 2018 than in 2014 for NH AI/AN, NH Asian/NHOPI, and NH multiracial women, but the results were not statistically significant. The predicted probability of NICU admission was highest among women who were NH Black at 12.42%, and lowest among women who were NH AI/AN at 9.7%.

CONCLUSION:

NICU admissions may be increasing among some neonates of pregnant women with gestational diabetes, and there are disparities in admission rates when accounting for race and ethnicity.