bluuebunny/crossref_metadata_2025 huggingface dataset:
A Multi-Modal Approach to Increasing Knowledge and Comfort of OBGYN Residents in Pelvic Organ Prolapse [5G]
Authors: Zyman Mark , Yuan Valerie , Liao Christina , Navas John , Yazdany Tajnoos
Published: May 2017

INTRODUCTION:

Nearly 46% of Obstetrics and Gynecology (OBGYN) residents feel unsatisfied with their Female Pelvic Medicine and Reconstructive Surgery (FPMRS) training. Residents in 85% of residency programs can satisfactorily perform four of ten basic FPMRS procedures at graduation. We describe implementing a multi-modal and interactive intervention to improve resident knowledge and comfort with counseling and treating patients with pelvic organ prolapse (POP).

METHODS:

Using VAS scales and multiple choice questions, we assessed the knowledge and comfort levels of managing basic POP among all OBGYN residents during the 2014-2015 academic year. Each resident underwent a 45 minute didactic involving multi-media training modules using the Boston Scientific Pop-Q application and a high-yield POP lecture prior to their FPMRS rotation. The same exam was given four months after completing the rotation.

RESULTS:

Of 19 residents enrolled, 18 completed the study. Comfort levels increased by 18.7% (P < 0.01). The pre and post-intervention mean scores were 383 and 533 points with a mean change of 150 (P<=0.01). POP knowledge scores increased by 9.6% (P < 0.05). The pre and post-intervention mean scores were 2.88 and 3.55 points with a mean change of 0.67 (P < 0.05). The intervention was well received and requested to be implemented into the curriculum.

CONCLUSION:

A high yield, multi-modal didactic immediately prior to immersion in patient care significantly improved knowledge, satisfaction and comfort level of POP, regardless of resident training level. This was retained even after completion of the rotation. Educational efforts for basic FPMRS topics should be multi-modal to enhance OBGYN resident knowledge and comfort levels.
Determinants of Ethical Concern With Multifetal Pregnancy Reduction Among U.S. Women of Reproductive Age [17G]
Authors: Lim Esther , Collins Stephen C.
Published: May 2017

INTRODUCTION:

Multifetal pregnancy reduction (MFPR) is recognized by the American College of Obstetricians and Gynecologists and the American Society of Reproductive Medicine to be a challenging ethical decision. This study explores the determinants of ethical concern with MFPR among U.S. women of reproductive age.

METHODS:

Data were obtained from the National Survey of Fertility Barriers (Wave 1, 2004-2007), a random digit dialing telephone survey of 4,794 women aged 25-50. Logistic regression was performed to determine the relationship between ethical concern with MFPR and religion, obstetric history, history of infertility, and history of infertility treatments.

RESULTS:

Only 14.7% of respondents had no ethical concerns with MFPR, while 44.3% expressed serious concerns. Serious ethical concerns were less likely among women with a history of abortion (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.31-0.58) or with no religious affiliation (OR 0.47, 95% CI 0.31-0.70). Serious ethical concerns were more common among women with a history of multiple gestation (OR 3.30, 95% CI 1.44-7.56) or who attend a weekly religious service (OR 1.55, 95% CI 1.16-2.08). After adjustment, religiosity remained a significant determinant of having serious ethical concern with MFPR (OR 1.18, 95% CI 1.12-1.24). History of infertility and its treatment had no significant association with ethical concerns about MFPR.

CONCLUSION:

A majority of U.S. women have ethical concerns with MFPR. While religiosity is a significant determinant of this concern, infertility and infertility treatments are not. The overall high level of ethical concern with MFPR underscores the importance of minimizing multiple gestations during infertility treatment.
Factors Associated With Dissatisfaction Among Obstetricians and Gynecologists in the United States [19G]
Authors: Cha Sandolsam , Smith Heather A. , Atallah Fouad , Chalas Eva , McCalla Sandra , Goffman Dena
Published: May 2017

INTRODUCTION:

There is growing concern about physician burnout and dissatisfaction. Characterizing sociodemographic and practice-environment characteristics associated with dissatisfaction among obstetricians and gynecologists (OB-GYNs) can aid in developing mechanisms to better support physicians and promote wellness.

METHODS:

A 24-question survey querying sociodemographic and practice-related information was electronically distributed nationally to board-certified OB-GYNs. The primary outcome was dissatisfaction in clinical and personal domains. Univariate analyses were performed using chi-squared/Cochran-Mantel-Haenszel statistics, and multivariable by logistic regression.

RESULTS:

Of the 5005 respondents, 28.9% were dissatisfied with clinical workload and 35.5% with their ability to meet personal responsibilities. Following regression, factors associated with dissatisfaction in 3 or more domains include: female gender (Adjusted Odds Ratio (aOR) 1.50, 95% Confidence Interval (CI) 1.31-1.72), required call-shifts (aOR 1.18, 95% CI 1.04-1.34), more than 45 clinical hours weekly (aOR1.54, 95% CI 1.35-1.75), less than 6 hours of sleep nightly (aOR1.68, 95% CI 1.48-1.92), experience of major fatigue-related consequences (aOR5.99 95% CI 4.63-7.75), and work-related stress (aOR 4.2, 95% CI 3.0-5.7). Protective factors include laborist practice (aOR 0.50, 95% CI 0.35-0.74) and receipt of incentive-pay in addition to base salary (aOR 0.82, 95% CI 0.69-0.96). Among respondents who reported fatigue-related consequences, factors associated with resilience against dissatisfaction include being married (aOR 0.71, 95% CI 0.59-0.85) and practice-designs of laborist (aOR 0.46, 95% CI 0.32-0.67) or small private group (aOR 0.70, 95% CI 0.57-0.85).

CONCLUSION:

Identifying individuals or populations at increased risk for dissatisfaction can help development of interventions on both individual and systems-level, and provide insight into enhancement of future practice designs.
Improving Provider Readiness for Intimate Partner Violence Screening [35G]
Authors: Lee Amy S. D. , McDonald Lynn , Wahab Maybel , Will Susan , Lee Judy M. , Coleman Jenell
Published: May 2017

INTRODUCTION:

Intimate Partner Violence (IPV) is a significant public health issue. Around 30% of American women yearly experience IPV with a lifetime incidence as high as 50%. An interprofessional team collaborated to increase and standardize IPV screening of women presenting for outpatient obstetric and gynecologic care through integration of a validated IPV screening tool into the electronic medical record (EMR).

METHODS:

The team evaluated provider readiness for IPV screening pre- and post- intervention through the use of The Domestic Violence Health Care Provider Survey Scale (DVHCPSS). An intervention was implemented that included the EMR integration of a validated IPV screening tool, the creation of an automated resource telephone system, and the education of providers regarding screening and response. The DVHCPSS is scored cumulatively for an overall score and may also be divided into six interest areas. Pre- and post-intervention DVHCPSS scores were compared using an independent Student t-test.

RESULTS:

Mean age (31 to 40) and years of clinical practice (11 to 15) was the same for both pre- and post-intervention survey respondents. There was an overall significant improvement in provider readiness (P=.003) with specific areas of significant improvement in “Professional Role Resistance/Fear of Offending the Patient” (P < .0001), “Blame Victim Items” (P=.0029), and “Perceived Self Efficacy” (P=.0064).

CONCLUSION:

Adopting and integrating a validated IPV screening tool into the EMR paired with provider education was associated with an improvement in provider readiness for IPV screening. Ultimately, this aims to be a blueprint for IPV screening and referral across this community and others.
Microbial Profiles and Tumor Markers From Culdocentesis: A Novel Screening Method for Epithelial Ovarian Cancer [3H]
Authors: Candel Sofia , Karr Mallory , Brard Laurent , Thomson Jongjin Anne , Groesch Kathleen , Braundmeier-Fleming Andrea
Published: May 2017

INTRODUCTION:

Epithelial ovarian cancer (EOC), the most prevalent type of ovarian cancer, has a low five-year survival rate because it is commonly diagnosed in later stages of disease. There is a critical need for early screening methods to improve mortality outcomes. Specific bacterial populations (microbiome) have been linked to various diseases but not investigated with EOC. We hypothesize that patients with EOC have a unique microbiome and this used in conjunction with tumor markers from culdocentesis and serum, would benefit EOC diagnosis and prognosis.

METHODS:

Study population includes women aged 30 or older, undergoing surgery for an adnexal mass or ovarian malignancy at two hospitals in Springfield, IL. Exclusion criteria are previous malignancy within last 5 years and inability to perform culdocentesis. On the day of surgery, serum and culdocentesis samples were analyzed for CA-125/HE4 concentrations while culdocentesis samples were also sequenced for bacterial V4 rDNA. Associations of microbial profiles with tumor marker levels will be calculated using models developed for biomarker discovery.

RESULTS:

Currently, 30 patients (10 EOC, 20 benign) have been analyzed for CA-125/HE4. Preliminary results showed elevated tumor markers in EOC serum and culdocentesis but higher EOC positive and negative predictive values in serum than culdocentesis. Microbial profiles recently identified will be correlated to sample tumor marker levels.

CONCLUSION:

Culdocentesis tumor marker levels significantly correlated with EOC although less than serum levels. Additional analysis of microbial profiles may advance current screening methods and personalized treatment strategies, potentially increasing survival rates of patients with EOC.
Robotic Versus Traditional Laparoscopy in Benign Hysterectomy: A Single Institution Experience [13H]
Authors: Friedman Caroline , Tierney Christina , Nasioudis Dimitrios , Fields Jessica , Zhou Zhen Ni , Holcomb Kevin
Published: May 2017

INTRODUCTION:

Robotic-assisted laparoscopy in benign hysterectomy remains controversial, and current evidence suggests similar outcomes when compared to traditional laparoscopic hysterectomy. This study sought to compare clinical outcomes between the two types of procedures at a single academic institution.

METHODS:

The electronic medical records of 133 women treated with robotic hysterectomy (RH) and 69 patients treated with traditional laparoscopic hysterectomy (TLH) for benign indications between September 2011 and December 2014 were reviewed. Clinical outcomes were compared using univariate and multivariate analyses.

RESULTS:

Patients undergoing RH were older (median 57 vs 48 years, P < .001) and less likely to be obese (18.8 vs 34.8%, P=.017). Operative time was similar for RH and TLH (203.0 vs 204.5 minutes, P=.973), despite a higher rate of concomitant procedures in robotic cases (32.3 vs 7.2%, P < .001). TLH was associated with higher rates of conversion to laparotomy (11.6 vs 1.5%, P=.003), blood loss greater than 1,000 mL (5.8 vs 0.8%, P=.047), and hospital stay greater than 2 days (21.7 vs 7.5%, P=.004). There were no significant differences in intraoperative or postoperative complications between groups. Multivariate logistic regression controlling for body mass index and specimen weight found total operative time (P=.006), estimated blood loss (P=.002), and TLH (P=.04) to be independent predictors of conversion to laparotomy.

CONCLUSION:

In our population, robotic-assisted hysterectomy was associated with lower rates of intraoperative hemorrhage, conversion to laparotomy, and extended hospital stay when compared to traditional laparoscopy. Such data support the utilization of robotic assistance in laparoscopic hysterectomy for benign indications.
Phase 2 Study of Relugolix vs Placebo in Heavy Menstrual Bleeding Associated With Uterine Fibroids [17H]
Authors: Hoshiai Hiroshi , Seki Yoshifumi , Kusumoto Takeru , Kudou Kentarou , Komura Emiko , Tanimoto Masataka
Published: May 2017

INTRODUCTION:

Relugolix is a potent nonpeptide gonadotropin-releasing hormone receptor antagonist. This dose-finding study explored the ability of relugolix to decrease the heavy menstrual bleeding (HMB) associated with uterine fibroids (UF).

METHODS:

This randomized, double-blind, placebo-controlled, phase 2 study was designed to evaluate relugolix 10 mg, 20 mg and 40 mg administered orally once daily for 12 weeks in Japanese women with UF and HMB defined as a Pictorial Blood Loss Assessment Chart (PBAC) score of at least 120. The primary endpoint was the proportion of women with a total PBAC score of less than 10 from Week 6 to 12. Secondary endpoints included the proportion of women with amenorrhea, and myoma and uterine volumes.

RESULTS:

Patients (N = 216) were randomized to placebo or one of three relugolix groups. The proportion of patients with PBAC score of less than 10 from Week 6 to 12 was 0% in placebo group, and 20.8%, 43.6% and 83.6% in relugolix 10 mg, 20 mg and 40 mg groups (P < 0.001 vs placebo).74% of patients in relugolix 40 mg group achieved amenorrhea, and a dose-dependent decrease in myoma and uterine volumes were observed. The incidence of headache, metrorrhagia, menorrhagia, and hot flush were more than 10% higher in relugolix 20 mg and 40 mg groups than in placebo group; these AEs were mild or moderate in severity.

CONCLUSION:

Treatment with relugolix showed significant dose-dependent decreases in menstrual blood loss compared with placebo and was generally well-tolerated with AEs consistent with the drug’s mechanism of action.
Trends in Hysterectomy After Cessation of Power Morcellation [19H]
Authors: Susla Lyudmyla , Brown Amy , Einstein Margaret , O'Sullivan David , Shafer Aaron
Published: May 2017

INTRODUCTION:

In April 2014, the FDA issued a warning against use of power morcellators. Soon after, their use was banned at many hospitals, including Hartford Hospital. There have been numerous position statements for and against these bans. We sought to examine the effect of this ban on women undergoing hysterectomy at Hartford Hospital. We hypothesized a decrease in minimally invasive hysterectomy after the morcellator ban.

METHODS:

This was a retrospective cohort study of all women who underwent hysterectomy for benign indications at Hartford Hospital from May 2013 to April 2015. We grouped patients into those who had surgery before 5/1/14 (pre-ban) and those after 5/1/14 (post-ban). Excluded were those women undergoing hysterectomy for gynecologic malignancy or those undergoing surgery for utero-vaginal prolapse and/or incontinence.

RESULTS:

1082 women met all inclusion criteria; 578 had hysterectomy pre-ban and 505 post-ban. Power morcellation decreased from 12.6% pre-ban to 0.4% post-ban, p < 0.001. There was no difference in the percentage of open hysterectomies, 13.3% (77) pre-ban and 14.8% (75) post-ban, p=0.47. Supracervical hysterectomies decreased from 9.9% to 3.2% (p < 0.001). There was no increase in conversion to laparotomy (2.4% vs. 1.8%, p=0.47), use of “manual morcellation” (19.3% vs. 23.8%, p=0.12) in minimally invasive procedures, mean length of stay (1.3 vs. 1.2 days, p=0.20) or blood loss (151 vs. 163 mL, p=0.69). 2 leiomyosarcomas were found, both post-ban.

CONCLUSION:

While we do not disagree with many of the criticisms to the FDA’s morcellator ban, it has not led to a decrease in access to minimally invasive hysterectomy at our institution.
The Association Between Surgical Route and Perioperative Outcomes for Women Undergoing Myomectomy [25H]
Authors: Sappenfield Elisabeth , Miladinovic Branko , Sarkar Papri , Imudia Anthony , Mikhail Emad
Published: May 2017

INTRODUCTION:

Fibroids are the most common solid pelvic tumor. Most symptomatic fibroids are managed surgically. The abdominal approach to myomectomy is more commonly performed than the laparoscopic approach. Primary objectives include examining the association between the route chosen for myomectomy and the 30-day perioperative outcomes for women undergoing the procedure.

METHODS:

Data for this retrospective review was obtained from the American College of Surgeons-National Surgical Quality Improvement Project database. Using Current Procedural Terminology. All women over the age of 18 years who underwent a myomectomy from 2005-2014 were included. A mixed-effects logistic regression analyses were performed to analyze the association between the route of myomectomy and 30-day perioperative outcomes, and to control for confounding factors including age, race, and fibroid weight.

RESULTS:

2,862 women underwent myomectomy; 1,207 were laparoscopic (42%) and 1,655 were open (58%). Laparoscopic myomectomy was less likely to be utilized for fibroids larger than 250 gm (45.9%) versus less than 250 gm (54.1%) [ORadj (95%CI)] [0.737 (0.575, 0.946)]. Laparoscopic myomectomy was associated with decreased length of hospital stay 0 d versus 2 d [ORadj (95%CI)] [0.143 (0.123, 0.167)], and longer operating times 157 m versus 116 m [ORadj (95%CI)] [1.014 (1.012, 1016)] compared to open myomectomy. There was no significant difference in readmission rate, postoperative urinary tract infection and pneumonia, and occurrence of deep vein thrombosis.

CONCLUSION:

Laparoscopic myomectomy was utilized less frequently for fibroids larger than 250 gm. Laparoscopic myomectomy was associated with a shorter hospital stay but a longer operative time.
The Accuracy of the Pelvic Exam Compared to Ultrasound and Pathology Measurements Based on Body Mass Index [28H]
Authors: Olsen Nina S. , Downing Perrin , Grasso Mackenzie , Murag Soumya , Truong Mireille
Published: May 2017

INTRODUCTION:

The purpose of this study was to evaluate the accuracy of pelvic exam when compared to ultrasound measurements and pathology weight depending on BMI. To our knowledge, there are limited studies evaluating the effect of BMI on accuracy of bimanual examination and a more recent investigation is long overdue.

METHODS:

This was a retrospective chart review of patients over the age of 18 undergoing hysterectomy for benign indications between July 2010 and July 2015. Bimanual examination and ultrasound measurements of the uterus prior to surgery were compared to pathology weight and then their accuracy was compared based on BMI. Concordance correlation coefficients were used to estimate accuracy of these measurements. Bland-Altman plots were used to compare the weights from clinical exam and ultrasound to the actual pathology weight.

RESULTS:

981 records were reviewed, of those 364 met inclusion criteria. Average weight of the uterus was 454.04 gm (+/-475.27). Average age and BMI of women undergoing hysterectomy was 45.5 years (+/-7.5) and 31.65 (+/- 7.09) respectively. Overall concordance between the three different methods of estimating uterine size ranged from 0.73 to 0.82. Concordance did not differ significantly between different BMI categories.

CONCLUSION:

The findings of pelvic exam are similar to ultrasound measurements when compared to pathology weight regardless of BMI whenever the uterine size can be estimated. These results suggest that if uterine size can be assessed, ultrasound may not be necessary for preoperative evaluation.
Hysterectomy- Vaginal, Abdominal and Robotic Laparoscopic Study: Clinical Evaluation and Cost Analysis [29H]
Authors: Hanafi Magdi
Published: May 2017

INTRODUCTION:

This study compared postoperative clinical outcome and hospital cost for Total Vaginal (TVH), Total Abdominal (TAH) and Robotic Laparoscopic (RLH) Hysterectomy.

METHODS:

Retrospective study for all hysterectomy cases from January 1st 2008‒December 31st 2015 performed by the author. Patients were divided into three groups: TVH, TAH and RLH. Postoperative clinical outcome surveyed by questionnaire. Data collected from the office and hospital electronic medical records and used to determine patient demographics, hospital stay, and operative time, estimated blood loss (EBL) and total hospital charges. A total of 333 patients were reviewed and 230 patient questionnaires were completed (69.06%).

RESULTS:

TAH had a significantly higher hospital stay of 2.8 days compared to TVH and RLH with 1.41 days. RLH had a significantly higher operative time (194.11 min) than TVH (119.75 min) and TAH (181.66 min). The EBL significantly higher in TAH (194.16 mL) than RLH (105.67 mL) and TVH (97.11 mL). No significant differences in hospital charges between TAH and RLH but both TAH and RLH had significantly higher total charges than TVH. TAH had a higher level of post-operative pain than RLH, no significant difference in pain level between other methods.

CONCLUSION:

A significantly higher hospital stays in TAH vs. all other methods. TAH and RLH had significantly higher hospital charges vs TVH. TAH had significantly higher in EBL than RLH. TAH had higher level of postoperative pain than RLH and TVH. The Learning curve has a significant impact on the operative time of RLH and subsequently it’s cost.
Narcotic Prescriptions for Benign Gynecologic Procedures in a Tertiary Care Facility [30H]
Authors: Moss Chailee , Isley Michelle
Published: May 2017

INTRODUCTION:

Narcotic addiction has been linked to legal prescription of narcotics by physicians. Narcotic prescriptions for gynecologic surgical procedures vary widely and little data exist to quantify prescribing practices. The present study aimed to describe narcotic prescription practices in gynecologic surgeries.

METHODS:

We examined gynecologic cases in a retrospective chart review of 8 months from 2014 to 2015. Patient characteristics (age, weight, insurance status, prior narcotic prescription, race, ethnicity, resident team or private physician) and discharge prescription data were collected from 549 cases. Prescriptions were converted into equivalent oral morphine doses for comparison (e.g. 5 mg oxycodone equals 7.5 mg oral morphine).

RESULTS:

Prescriptions associated with open gynecologic procedures were significantly larger than all other procedure types (P < .001); inpatient laparoscopy prescriptions were larger than any outpatient procedures (P < .001). Mean total prescriptions for surgery categories (in milligrams of oral morphine) were: vulvar and cervical - 90; uterine (e.g. hysteroscopy, dilation and curettage) - 50; outpatient laparoscopy - 137; inpatient laparoscopy and vaginal surgery - 267; and open - 323. No significant differences were correlated to age, weight, race, insurance, or care team. Of note, 43% of patients had a narcotic prescription in the five years preceding surgery.

CONCLUSION:

Narcotic prescription practices are widely varied, and significantly different between procedure types. Many patients have prescription narcotic exposure prior to a gynecologic procedure. More study is needed to evaluate how much narcotic patients utilize for gynecologic procedures to avoid excessive prescribing.
Provider Differences in Outcomes of Low-Risk TOLAC Patients: Comparing Midwifery and Obstetrician Management [34H]
Authors: Fore Matthew S. , Allshouse Amanda , Carlson Nicole S. , Hurt K. Joseph
Published: May 2017

INTRODUCTION:

Provider management may influence the success of trial of labor after cesarean (TOLAC). This study examined the role of the provider, MD-obstetrician (OB) or certified nurse midwife (CNM), in explaining differences in unplanned cesarean delivery (uCD) during TOLAC for low-risk women.

METHODS:

We performed a secondary analysis of a cohort prospectively enrolled from 2005 to 2012 at the University of Colorado Hospital. We compared the probability of uCD by provider type in logistic regression and in multivariable modeling, adjusting for maternal, pregnancy, fetal, and neonatal covariates. Results are odds ratios with 95% confidence intervals. Maternal and combined neonatal-maternal adverse morbidity composites were compared by provider type.

RESULTS:

216 OB-managed versus 286 CNM-managed deliveries were similar in average maternal age, BMI, and proportion of race/ethnicity and were not significantly different for risk of uCD (0.78, 0.45-1.37). Adjusting for onset of labor, race/ethnicity, obstetric history, and recurring indication showed no significant difference in risk of uCD between OB- versus CNM-managed deliveries (0.60, 0.32-1.12). While OB- versus CNM-managed deliveries did not significantly differ in overall adverse composite outcome (1.24, 0.81-1.90), odds of maternal morbidity were greater in OB-managed deliveries (1.62, 1.02-2.56).

CONCLUSION:

There is no significant difference in unplanned cesarean between provider types, suggesting that provider type alone does not predict TOLAC success in low-risk women but may predict differences in maternal morbidity in this specific population. Further investigation of individual between-provider differences rather than provider groups could help target interventions to reduce uCD and increase TOLAC success in the United States.
Put Your Oxygen Mask on First - Perinatal Psychiatric Emergencies: A Reproductive Psychiatrist’s Perspective [1I]
Authors: Rodriguez-Cabezas Lisette , Clark Crystal , Yang Amy , Pendergrast Tricia , Miller Emily , Wisner Katherine
Published: May 2017

INTRODUCTION:

There is not much data on the management of perinatal psychiatric emergencies in the current literature despite the increased attention that they have received in the media recently. This presentation will provide the data that is currently available, including a retrospective analysis of our own institution, and provide guidelines to direct clinical care.

METHODS:

A literature search was performed to analyze all of the available published data on perinatal psychiatric emergencies. Also, a retrospective data analysis was performed at our own university hospital looking at use of restraints, psychotropic medications, and or both in the treatment of pregnant women who presented to the emergency department. Data on chief complaint, demographics, and final disposition were also analyzed.

RESULTS:

The data is still being analyzed but a good proportion received psychotropics and went on to be psychiatrically hospitalized. Restraints were a rare event. According to the literature search, some conclusions can be drawn as to which medications and treatments may be less risky for certain emergencies. Of note, there were a considerable number of patients whose chief complaint was medical but ultimately were psychiatrically assessed and admitted.

CONCLUSION:

This is, to our knowledge, the first retrospective analysis of emergency room data on the management of perinatal psychiatric emergencies. These data will be the basis for future research in this field which deserves more attention due to the dearth of information currently available.
Obstetrics and Gynecology Residents’ Assessment of Clinical Genetics Competence [3I]
Authors: Adjei Naomi , Friedman M. Alexandra , Wenstrom Katharine
Published: May 2017

INTRODUCTION:

Although OB-GYNs must increasingly deal with genetic issues, the adequacy of their education in genetics is unknown. We investigated residents’ sources of genetics information and their perceived knowledge and comfort level with 13 established core genetics competencies, as well as common genetics issues.

METHODS:

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

RESULTS:

195 residents from 51/292 programs (17.5%) participated in the study. Residents uniformly reported high perceived importance of counseling patients about specific genetic issues: Fragile X syndrome (171, 99%), cancer genetics (172, 100%), prenatal screening (170, 99%), and interpreting cell free DNA results (168, 98%). However, a majority of residents reported having good/very good knowledge level of only 3 of 13 genetics core competencies: chromosome abnormalities (87, 51%), prenatal screening testing (68, 40%) and taking family history (81, 47%). The majority reported fair, poor, or very poor knowledge of preconception counseling; multifactorial, mendelian, and non-mendelian inheritance; single gene disorders; population genetics; screening at-risk populations; cancer and molecular genetics; and constructing a pedigree. Residents reported obtaining clinical genetics information primarily from guidelines and practice bulletins (108, 63%), although 30% (52) of residents reported no good source of clinical genetics information.

CONCLUSION:

OB-GYN residents perceive their knowledge of genetics to be inadequate, and are unaware of appropriate sources for genetics information. Resident genetics education must be improved.
Clitoral Restoration After Female Genital Mutilation [4I]
Authors: Henning Harold
Published: May 2017

INTRODUCTION:

To see if clitoral restoration is a valid, repeatable and acceptable procedure for women who have had female genital mutilation in the past.

METHODS:

Retrospective review of 25 patients that voluntarily underwent the clitoral restoration procedure.

RESULTS:

Twenty-five patients underwent clitoral restoration from July 2012 to October 2015. Fourteen responded to follow up questioning: Of those that responded 13 out of 14 (93%) said they were glad they had the surgery done and 11 out of 14 (79%) said that their sense of pleasure had been restored. Overall, if the non-respondents were considered as a negative response then 13 out of 25 (52%) were glad and 11 out of 25 (44%) had pleasure after having the surgery performed.

CONCLUSION:

FGM clitoral reconstruction appears to be a valid surgical procedure to consider for women who have had FGM done to them against their will.
Trends in Social Media and Mobile Applications Among Medical Students Entering Obstetrics and Gynecology [7I]
Authors: Purusothaman Vaishnavi , Ramsey Patrick S. , Miller Katherine , Page-Ramsey Sarah M.
Published: May 2017

INTRODUCTION:

Increasing popularity of social media and mobile devices has greatly impacted medicine. The potential implications in patient care have resulted in formal policies in many healthcare institutions. We sought to identify trends in social media, use of mobile technology, and exposure to social media training and policies among medical students entering OBGYN.

METHODS:

We surveyed all medical students attending the national American College of Obstetricians and Gynecologists Annual Medical Student Course from 2012-2016 regarding social media use, use of mobile medical applications, and prevalence of medical school social media policies and training. Descriptive statistics and Chi-squared analyses were performed as appropriate.

RESULTS:

742 of 815 (91%) students from 48 states responded. Most (68%) were third-year students, women (84%), and age 20-30 years (92%). Social media use increased from 81% to 94% of students (p=0.0001). Facebook™ was the most commonly used site. Mobile medical applications were used by 92% of students; 89% thought medical applications were helpful in learning. The most commonly used applications were Epocrates™ (77%) and UpToDate™ (76%). Medical school policies and training in social media increased from 23% to 37% (p=0.0065) and 35% to 57% (p=0.0004) respectively.

CONCLUSION:

Medical students planning to pursue OBGYN report increasing use of social media and medical school policies and training in social media. Mobile applications are frequently used as a valued method of learning in the clinical setting. These trends will likely impact learning and patient care, and can be useful in developing educational curricula and communication platforms for our next generation of OBGYNs.
Bright Pink’s “Assess Your Risk” Patient Survey: Feasibility of Utilizing Social Media for Research [12I]
Authors: Lindner Deborah , Vasic Jelena
Published: May 2017

INTRODUCTION:

Recent studies have highlighted strengths of utilizing social media to recruit for and conduct research when compared to traditional methods. Our study aims to confirm the feasibility of using social media to recruit large numbers of research participants to Bright Pink’s digital “Assess Your Risk” breast and ovarian cancer risk assessment survey.

METHODS:

Data was obtained from participants driven by Facebook advertising to the “Assess Your Risk” survey between April 1st and September 30th, 2016. Advertisements appeared on the pages of Facebook users whose profiles matched the following inclusion criteria: female, ages 18-45, with interest in either breast and ovarian cancer topics, social impact brands, or fitness.

RESULTS:

The Facebook advertisements garnered 6,865,108 impressions, defined as the number of women exposed to the advertisements. 192,546 of those exposed to the advertisements clicked on them, and of those, 84.3%, or 162,132 women, went on to complete the 19 question assessment quiz. Cost per completion was $0.16 compared to email ($15-25) or mail ($25-35) surveys.

CONCLUSION:

Internet recruiting through social media has been an underused strategy in attracting individuals in health research. The response rate of the Assess Your Risk survey tool shows the potential to harness data collection to conduct meaningful and cost-effective research through the use of social media advertising.
Palliative Care Rotations in Obstetrics and Gynecology, Internal Medicine, and Family Medicine Residency Programs [14I]
Authors: Bazzi Mohamad , Tyagi Sarika , Bazzi Ali , Uppal Shitanshu
Published: May 2017

INTRODUCTION:

To determine the number of obstetrics and gynecology, internal medicine, and family medicine residency training programs with mandatory palliative care rotations.

METHODS:

We included internal medicine, family medicine, and obstetrics and gynecology programs listed on the Fellowship and Residency Electronic Interactive Database. Program information such as the number of residents per year, geographic location and monthly block schedule for each program were obtained. If the block schedule explicitly mentioned mandatory palliative care rotation for at least two weeks, programs were categorized as: mandatory palliative care program.

RESULTS:

Overall, 12.4% (146/1,177) programs had mandatory rotation as part of the residency training. Rates of mandatory palliative care rotation were highest amongst the programs in the West-Pacific (29.2%) and lowest for the West-Mountain (3.5%) residency programs. Internal medicine programs had higher mandatory palliative care rotations compared to Family Medicine (17.6% vs 14.3%, P=.048). Obstetrics and Gynecology had the lowest rate at 0.8%. From these programs, 16.2% (2,181/13,434) of the graduating residents each year had mandatory palliative rotation exposure.

CONCLUSION:

Our findings highlight the lack of focus on primary palliative care training. Despite recommendations from the Institute of Medicine, based on our analysis, majority of graduate medical training programs do not incorporate palliative care in the curriculum. Incorporating palliative care training with other mandatory subspecialty trainings rotations (e.g. cardiology or oncology) would be an important step in this direction to assure the delivery of high-quality end-of-life care.
Patient Information About Zika Virus and Perinatal Risks on State Health Department Websites in the United States [17I]
Authors: Menchaca Ryan , Page-Ramsey Sarah M. , Rodriguez Emma , Gray Jordan , Ireland Kayla , Ramsey Patrick S.
Published: May 2017

INTRODUCTION:

Zika virus infection is an emerging health threat in pregnant women. It is important that obstetric patients or women considering pregnancy can access up-to-date information about Zika. Our objective was to evaluate the availability of patient-level information about the Zika virus and perinatal risks on state health department websites in the United States and its territories.

METHODS:

We reviewed each U.S. state, District of Columbia and its territories (Puerto Rico, Guam, US Virgin Islands, American Samoa, North Marianas Islands) health department websites and abstracted patient information available on the Zika virus, pregnancy risks, prevention measures, mosquito repellants, sexual transmission, endemic areas, and travel guidance. In cases where information did not appear immediately on the main webpage, an internal search of the site using the term “Zika” was performed.

RESULTS:

96.4% of the 56 state/territory health department websites contained patient information about Zika virus. Information was more commonly found on state websites than on territories websites (98.0% vs 60.0%). Among the state/territory websites with any Zika information, specific information noted details about the Zika virus (98.1%), pregnancy risks (84.6%), risk of microcephaly (76.9%), sexual transmission (82.7%), mosquito repellant use (71.2%), travel avoidance (84.6%), and Zika endemic areas (90.1%).

CONCLUSION:

Patient access to Zika virus information is available on most US state and territory health department websites, though less common on territory sites. Because patients need to easily access educational information about Zika virus infection in pregnancy, we should aim to have this information available on all state and territory sites.
Innovative Educational Tool to Enhance Hysteroscopy Learning [18I]
Authors: Hammer Karissa , Fogg Louis , Tam Teresa
Published: May 2017

INTRODUCTION:

It has been established that hands-on training is known to improve resident learning. However, few have investigated lecture content and improvement of resident education on hysteroscopic instrumentation and assembly. This study evaluates a standardized educational curriculum in hysteroscopy for obstetrics and gynecology (OB/GYN) residents.

METHODS:

A standardized hysteroscopic curriculum was developed in line with American College of Obstetricians and Gynecologists hysteroscopy training guidelines. The curriculum consists of a one-hour lecture followed by a hands-on hysteroscopic instrumentation session. Participants were given a pre-test prior to the lecture and a post-test after subsequent lectures. Residents from three different institutions in Chicago, Illinois from 2013 to 2016 were tested. Instrument assembly was graded by time spent for task completion.

RESULTS:

Repeated measures analysis of variance was used to assess data points, pre and post test scores compared by training year and overall improvement. There was a statistically significant score difference in each level of training from pre to post-test. This difference was linear, magnitude of effect the same on each training level (N=29, P value 0.035). On average, scores improved by 14%. Hysteroscopic assembly time decreased by 2.45 minutes (N=14, P value 0.03). Improvements did not change with level of training but were only related to exposure to lecture content.

CONCLUSION:

An established curriculum made significant change in residents’ knowledge of hysteroscopy and instrumentation as demonstrated by improved hysteroscopic assembly times and post-test scores. This tool demonstrated an impact in multiple residency programs and can be more widely applied to aid resident training in hysteroscopy.
Identification and Rating of Medical Translator Mobile Applications Using the APPLICATIONS Scoring System [32I]
Authors: Khander Amrin , Farag Sara , Chen Katherine
Published: May 2017

INTRODUCTION:

With an increasing number of limited-English proficiency (LEP) patients, many health care providers are turning to medical translator applications (apps) for assistance. However, no known published reviews or evaluations of these apps exist. Our objective was to identify and rate medical translator apps using the APPLICATIONS scoring system.

METHODS:

A list of apps was identified from the Apple iTunes and Google Play stores using the search term, “medical translator.” Apps not found on two different searches, not in an English-based platform, not used for translation, or not functional after purchase were excluded. The remaining apps were rated using the APPLICATIONS scoring system, which includes both objective and subjective criteria and evaluation of special features such as audio, microphone, and keyboard capabilities. App comprehensiveness was a weighted score defined by the number of non-English languages included in each app relative to the proportion of non-English speakers in the US.

RESULTS:

524 apps were initially found and 26 (9.2%) apps from the Apple iTunes store and 20 (8.2%) apps from the Google Play store remained after applying exclusion criteria. These apps were categorized as preset medical phrases (23 apps), medical dictionaries (16 apps), and general language translators (6 apps). The highest scoring app available on both platforms was Universal Doctor Speaker. Canopy scored highly in iTunes whereas Vocre Translate scored highly in Google Play.

CONCLUSION:

Using the APPLICATIONS scoring system, we have identified and rated medical translator apps that could prove useful to providers in caring for LEP patients.
Identification and Evaluation of Fetal Heart Rate Monitoring Mobile Applications [33I]
Authors: Soffer Marti , Chen Katherine
Published: May 2017

INTRODUCTION:

Regulation of medical applications (apps) has not been rigorous, yielding greater concern for inaccurate medical apps. This study aimed to identify mobile apps for fetal heart rate monitoring (FHM) and to evaluate their accuracy.

METHODS:

A list of FHM apps was found in the Apple iTunes stores using a comprehensive list of search terms. After excluding apps irrelevant to this study, all unique apps were downloaded and evaluated for request for personal information, necessary purchase of an accessory item, presence of disclaimer regarding medical advice, and accuracy of medical content. Those apps that did not require personal information, did not need purchase of an accessory item, and were not duplicates, were tested for accuracy and misinformation.

RESULTS:

A total of 30 unique FHM apps were generated. Of these apps, one required an in-app purchase to use, 6 apps requested personal information, and 4 apps required purchase of an accessory device and thus were not further evaluated. Of the 19 remaining, all (100%) of the applications were unable to detect the adult heart rates of the authors. Five apps were duplicates, 6 lacked disclaimers regarding medical use, and 5 provided false information.

CONCLUSION:

Identification of FHM apps that do not require personal information nor purchase of accessory item revealed that all apps were inaccurate. In addition, many apps did not provide a disclaimer and/or contained false information. Health care providers should understand the problems with these FHM apps, and educate their patients on the inaccuracies and potential dangers of the use of these applications.
A Rare Case of Primary Invasive Papillary Adenocarcinoma of Vulvar Lesion [4J]
Authors: King Robinette
Published: May 2017

INTRODUCTION:

Vulvar cancer accounts for approximately 5% of all female genital malignancies and is commonly recognized as a disease of postmenopausal women. The vast majority of vulvar carcinomas are of the squamous cell type (90%) with primary vulvar adenocarcinomas ranking among the rare gynecological malignancies, comprising less than 0.1% of the cases. This case report is a primary vulvar adenocarcinoma and discusses the diagnosis and the treatment of this unusual and uncommon neoplasm.

METHODS:

The clinical case was analyzed followed by a literature review on papillary adenocarcinoma of the vulvar.

RESULTS:

A 53-year-old postmenopausal African-American female presented with 1-year history of enlarging, otherwise asymptomatic left vulvar mass. A flesh colored 3 × 2 cm mobile, nodular lesion was noted on left anterior labia majora. An excisional procedure was completed. Final pathology revealed the skin to be benign with cyst wall and contents revealing moderately differentiated invasive papillary adenocarcinoma. Stains of the neoplastic cells were positive for p53 immunostain. Follow-up clinical evaluation did not demonstrate evidence of metastatic disease and the recommendations of the monthly multidisciplinary meeting was for ipsilateral lymph node dissection and modified radical vulvectomy of tumor bed. The patient declined diagnosis and recommended treatment.

CONCLUSION:

Adenocarcinomas of the vulva are exceedingly rare, making diagnosis and management difficult for pathologists and clinicians. As a result literature is very limited. This report will allow for further advancement in regards to the diagnosis and treatment of this unusual and uncommon neoplasm.
Using the Rothman Index to Identify Oncology Patients at Risk for Postoperative Readmission [6J]
Authors: Butz Anh , El Alam Michel , Irvin William , Stovall Dale
Published: May 2017

INTRODUCTION:

The Rothman Index (RI), a composite score from 0 to 100, is a previously validated, continuously computed score derived from over 50 clinical measures that assesses a patient’s clinical status. It has been used as a prognostic indicator in the ICU setting and can be incorporated into the EMR. This study was designed to determine its utility in assessing readmission rates in postoperative gynecologic oncology patients.

METHODS:

In this pilot retrospective case-control study, gynecologic oncology surgical patients readmitted within 30 days of discharge (cases) were matched 1:2 by procedure, diagnosis, age and comorbidities to non-readmitted gynecologic oncology surgical patients (controls). All procedures were performed at one center by a single surgeon. RI values were obtained immediately postoperative (RI-i) and before discharge (RI-f), and the difference between these values was calculated (RI-d). RI’s were compared between cases and controls using R software.

RESULTS:

A total of 24 cases were matched to 48 controls. The mean age was 56. RI-f was significantly different between groups and predictive of readmission (P = 0.017). An RI-f of 58 or less was associated with at least 51% likelihood of readmission. Cases and controls did not differ significantly based on RI-i or Ri-d, and they were similar with respect to risk factors including diabetes, smoking, and BMI.

CONCLUSION:

The RI value on the day of discharge is helpful in identifying postoperative gynecologic oncology patients at increased risk for readmission. Delaying discharge for patients with an RI below a designated threshold may reduce readmission rates.
The Association Between Perioperative Outcomes and BMI Among Patients Who Underwent TLH for Uterine Cancer [8J]
Authors: Al Sawah Entidhar , Salemi Jason , Sarkar Papri , Imudia Anthony , Hoffman Mitchel , Mikhail Emad
Published: May 2017

INTRODUCTION:

Greater degree of obesity can pose surgical challenges in patients who undergo open surgery. As total laparoscopic hysterectomy (TLH) is becoming utilized widely for uterine cancer, our objective is to assess the association between patient body mass index (BMI) and perioperative outcomes.

METHODS:

A retrospective analysis of the American College of Surgeons-National Surgical Quality Improvement (ACS-NSQIP) database during 2005-2013 was conducted. Women with uterine cancer who underwent TLH, including robotically-assisted and conventional routes, were identified. We used preoperative BMI (kg/m2) to estimate the degree of obesity as follows: normal (< 25), overweight (25-29.9), obese (30-39.9), and morbidly obese (≥40).

RESULTS:

TLH was performed in 3630 women with uterine cancer during 2005-2013. Of those, 15.9%, 18.9%, 36.9%, and 28.2% had normal, overweight, obese, and morbidly obese BMI. The mean operation time (minutes) was significantly higher in overweight (159), obese (158), and morbidly obese (171) women than women with normal BMI (145, p < 0.05). The wound infection rate in the morbidly obese group (1.3%) was higher than for normal (0.2%), overweight (0.1%), and obese (0.5%) women (p < 0.05). We did not observe an association between patient BMI and length of hospital stay, incidence of blood transfusion, or thromboembolic episodes.

CONCLUSION:

In women with uterine cancer, morbid obesity was associated with greater risk of deep wound infections and greater operation time following TLH. Hospital stay and readmission within 30 days was not affected by the level of obesity.