bluuebunny/crossref_metadata_2025_split huggingface dataset:
POC Assessment of Combined Umbilical Arterial and Venous Lactate: A Potential Screening Test for Neonatal Acidosis [OP04-7D]
Authors: Yordán Nora Torres , Lewis Ayodele G. , Brewster Reginald M. , Tolan Nicole V. , McElrath Thomas F. , Greenberg James A. 
Published: April 2020

INTRODUCTION:
Umbilical artery (UA) lactate and pH aid the diagnosis of neonatal acidosis. This study examines the relationship between point-of-care (POC) measurement of combined umbilical arterial and venous (CUAV) lactate and UA lactate and pH to determine whether this POC assessment could serve as an alternative screening modality for neonatal acidosis.

METHODS:
In this prospective cohort study, UA and CUAV cord blood samples were collected from vaginal and cesarean deliveries occurring between June and August 2019 at a tertiary care center. UA samples were analyzed for pH and lactate using a standard laboratory blood gas analyzer (GEM 4000). CUAV lactate was analyzed at the POC (StatStrip Xpress Lactate Meter, off-label indication, IRB-approved) as well as on the blood gas analyzer. Short-term neonatal outcomes, including 1- and 5- minute APGAR scores and NICU admission rates were also assessed.

RESULTS:
N=190. There was a statistically significant correlation between POC CUAV lactate concentrations and UA lactate concentrations (R2=0.806 P=2.2 x 10-16). Additionally, there was a statistically significant correlation between the CUAV lactate concentrations obtained using the POC device and the GEM analyzer (R2=0.934 P=2.2 x 10-16). R2=0.95 for technical replicates of POC CUAV lactate concentration measurements. There was no statistically significant association between POC CUAV lactate and UA pH (R2=0.223 P=2.4 x 10-6).

CONCLUSION:
POC testing of CUAV lactate is reliable and closely correlated with UA lactate concentrations, making POCT CUAV lactate a feasible screening test for neonatal acidosis. More data is needed to establish the sensitivity and specificity of this test and its association with clinical neonatal outcomes.
Multimodality Therapy Associated With Improved Outcomes in Patients With MSI-High Advanced Endometrial Carcinoma [33H]
Authors: McEachron Jennifer , Zhou Nancy , Spencer Christina , Chatterton Carolyn , Singhal Pankaj K. , Lee Yi-Chun 
Published: April 2020

INTRODUCTION:
Evidence suggests patients with microsatellite instability-high (MSI-high) endometrial carcinoma (EC) derive greater benefit from radiation therapy than their microsatellite stable counterparts. In the present study, we evaluated outcomes of MSI-high advanced EC treated with a combination of chemotherapy-radiation (C-RT) versus chemotherapy (CT) alone to determine if there is a progression free survival (PFS) benefit associated with a particular adjuvant therapy regimen.

METHODS:
From 2000 – 2016, a multicenter retrospective analysis of patients with MSI-high, stage III/IV EC was conducted. Inclusion criteria were patients with MSI-high EC who had undergone comprehensive surgical staging, followed by adjuvant CT or C-RT. MSI status was determined by immunohistochemistry (IHC) and molecular tumor profiles. Differences in the frequencies of histology, stage and cytoreduction status were identified using Pearson’s chi-square test. PFS was defined as time of surgery to time of recurrence. PFS rates were calculated using Kaplan-Meier estimates. IRB approval was obtained.

RESULTS:
Final analysis included 37 patients; 55% (n=20) C-RT and 29.5% (n=17) CT. The median age was 62 years (range 51-81); histology included 48.6% endometrioid, 40.5% serous, and 10.7% clear cell tumors. 92% of patients underwent optimal cytoreduction. There was no difference in the frequency of histologic subtypes (P=.83), stage (P=.12) or cytoreduction status (P=.73) between treatment regimens. There was a significant improvement in PFS in patients receiving C-RT (24 months) versus CT (17 months) which demonstrated a superior 2-year PFS compared to CT (40.0% vs 29.5%; P=.04).

CONCLUSION:
Multimodal adjuvant therapy with C-RT was associated with improved PFS in patients with MSI-high advanced EC.
Pediatric Gynecologic Malignancy and DICER1: A Case Series That Further Elucidates the Phenotype [35H]
Authors: Hayes Katherine , French Amanda 
Published: April 2020

INTRODUCTION:
Pediatric gynecologic malignancies are rare and may be linked to genetic syndromes. DICER1 syndrome, an emerging entity first described in pleuropulmonary blastoma, was more recently identified as a hereditary tumor predisposition syndrome that can be associated with gynecologic malignancies. Gynecologic manifestations of DICER1 syndrome have been described in single or small case reports with an array of pathologic findings. We seek to better define tumor pathology that should prompt testing for DICER1.

METHODS:
An IRB approved, retrospective chart review was conducted for all female patients less than 25 years old with sex cord stromal tumors at our institution between 1990 and 2019. Patients were included if they had a diagnosis of DICER, Sertoli-Leydig tumor, rhabdomyosarcoma, gynandroblastoma, or mixed sex cord stromal tumor.

RESULTS:
We identified 21 patients meeting inclusion criteria. Histologic descriptions were noted to be similar across all tumor types with all but one having numerous similarities. Seventeen had genetic testing of any type, although not all were identified for DICER1 testing. Nine of these (53%) had a somatic or germline DICER1 mutation.

CONCLUSION:
DICER1 syndrome is not well known in the gynecologic community. Although the histology of these tumors is complex and variable, a clear pattern emerges from our series. We present this as a phenotype that should prompt testing for DICER1, as the implications of germline mutations are lifelong. Obstetrician/gynecologists play an important role in testing, surveillance and diagnosis of additional primary tumors as the risk begins with conception and continues throughout the lifespan.
Preoperative Intrathecal Opioid Injection on Postoperative Analgesia Requirements in Gynecologic Oncology [37H]
Authors: Hou Eileen , Wheeler Michelle , Ioffe Yevgeniya , Yao Ruofan , Nour Mohamed , Hong Linda 
Published: April 2020

INTRODUCTION:
Decreasing opioid use during postoperative period is a topic of great ongoing interest. We aimed to determine whether regional anesthesia with single-shot intrathecal opioid injections (ITO) reduced intravenous (IV) opioid use after exploratory laparotomy in gynecologic oncology surgeries.

METHODS:
A retrospective chart review with institution IRB approval of 314 consecutive gynecologic oncology patients undergoing exploratory laparotomy from July 2015 to January 2018 was conducted. Single-shot ITO was offered to all patients undergoing open abdominal surgery. The primary outcomes of interest were self-reported post-operative pain levels and IV opioid use in morphine equivalents during the first 48 hours after surgery. Univariate analyses were performed to estimate the effect of ITO on IV opioid use at 0, 6, 12, 24 and 48 hours after surgery. The relationship between ITO and primary outcomes of interest were determined using longitudinal regression analysis and adjusted for confounding variables.

RESULTS:
34% (107/314) received ITO preoperatively. There were no differences in patient age, BMI, number of prior abdominal surgeries, history of opioid dependence, or EBL between the ITO and control groups. Preoperative ITO was associated with significantly lower IV opioid requirement between 0-6 hours after surgery (9.7±8.1 vs 14.3±11.5, P<.0001) and between 6-12 hours after surgery (2.7±3.8 vs 5.4±9.5, P=.0054). In addition to reduced IV opioid use in ITO group, no differences in self-reported postoperative pain levels were noted in the first 48 hours post-operatively.

CONCLUSION:
Preoperative ITO reduced postoperative opioid requirement for pain control without negatively affecting patients’ self-reported pain level.
“I’m Not Going to Jail for This,” an Analysis of Anesthesia Providers’ Responses to Georgia’s 22-Week Abortion Ban [01I]
Authors: Reeves Jennifer A. , Goedken Peggy , Cwiak Carrie , Hall Kelli 
Published: April 2020

INTRODUCTION:
State-level legal regulations affect abortion provision in the United States. Anesthesia providers participate in abortion care, and their understanding of legal regulations may impact their willingness to participate in hospital-based abortion care.

METHODS:
In-depth qualitative interviews were conducted with currently-practicing anesthesia providers, who care for obstetric (OB) patients. A semi-structured interview guide elicited information on providers’ personal abortion attitudes through case-based examples and a discussion of Georgia’s (GA) 22-week abortion ban. Data were analyzed in an iterative fashion using both inductive and deductive approaches.

RESULTS:
Thematic saturation of the primary aim occurred after 15 interviews. Participants represented many provider types, including anesthesiologists, certified and student registered nurse anesthetists, certified anesthesiology assistants, and anesthesiology residents. Most participants practiced general or OB anesthesiology in a hospital setting (n=14). Two-thirds of participants reported prior participation in abortion (n=10). Most providers had little to no prior knowledge of GA’s 22-week abortion ban (n=11) and perceived an overall neutral or negative impact of the law on OB practice (n=13). Prominent themes that emerged from the data included “fear of criminality,” “transfer of responsibility to the law,” and “retroactive versus proactive medical care,” which described how anesthesia providers reacted to state-specific legislation on abortion.

CONCLUSION:
Anesthesia providers are not well-informed of state-specific abortion legislation and demonstrate a mixed response to such laws. After introduction of GA’s 22-week ban, many participants reported a more conservative approach to participating in hospital-based abortion care, which affects abortion access in this setting.
A Novel IUD Platform Design Uses a Flexible Nitinol Frame to Deliver Either Copper or Levonorgestrel: Phase 2 Data [03I]
Authors: Turok David Keith , Peters Kevin , Katz Bob 
Published: April 2020

INTRODUCTION:
Current IUD applicators vary among copper and levonorgestrel devices. We present data on a new intrauterine contraceptive platform that uses a flexible nitinol frame provided in a preloaded applicator with precut strings and a tapered leading edge to deliver either low-dose copper (175 mm2) or a levonorgestrel (52 mg) IUD.

METHODS:
Two Phase 2 studies provide information, one for copper and the other for the levonorgestrel IUD. Subjects met standard inclusion & exclusion criteria for each IUD, per the CDC. IUD placement occurred any day in the menstrual cycle. The primary outcome for both studies was efficacy, measured by Pearl Index (PI). Secondary outcomes include placement success, ease, and pain as well as overall tolerability and safety.

RESULTS:
The copper and levonorgestrel IUD studies enrolled 286 and 279 women, respectively; 60.8% and 64.2% were nulliparous. Investigators described IUD placements as “easy” or “very easy” in 91.5% and 88.9%, while participants rated pain as “moderate” or “very painful” in 19.0% and 21.5%, respectively. Placement required cervical dilation in 41 (14.5%) and 42 (15.1%); 99% of placements were successful in both studies. One pregnancy occurred in the Copper IUD study (PI=0.73, 95% CI 0.09-2.65) and none in the levonorgestrel study (PI=0.0, 97.5% confidence upper bound=1.88). We identified no uterine perforations. First year expulsions occurred in 1 (0.4%) and 7 (2.5%) participants.

CONCLUSION:
This novel IUD platform design successfully delivers both a low dose copper and levonorgestrel IUD with promising efficacy and safety data.
Adoption of a Digital App-Based Fertility Awareness Based Method of Birth Control in the US [04I]
Authors: Pearson Jack T. , Rowland Simon P. , Scherwitzl Elina Berglund , Danielsson Kristina Gemzell , Scherwitzl Raoul 
Published: April 2020

INTRODUCTION:
In August 2018 the FDA cleared the first digital app-based fertility awareness method of contraception. We aimed to investigate patterns of adoption of this method since August 2018 and to explore the motivations of women who switched from other methods of birth control.

METHODS:
An electronic web based survey was sent out in the fall of 2018 to Women in the U.S. using the Natural Cycles app as a method of birth control. 1,218 Women responded, answering questions regarding age, marital status, parity, education, religion and political beliefs. Furthermore, they answered questions on their birth control preferences, previous methods, reasons for switching to a digital FABM and their view on the use of the Natural Cycles app.

RESULTS:
Demographics of Natural Cycles Users in the U.S were as follows: Mean age 30, 51% married, 82% nulliparous, 49% bachelor’s degree and 45% no religious belief in particular. The majority of users lived in California and had a presence in New York, Texas and Colorado. 60% of users had switched birth control method twice or more in their lifetime. 71% of users started using Natural Cycles to avoid using hormones.

CONCLUSION:
Over 560,000 women in the us have registered for the app since August 2018, the majority of whom live in California. Demographics of users include approximately 30 years old, in long term relationships, do not have children and are educated. Most of these women are driven to use a digital FABM to avoid the use of hormonal birth control.
Anti-Abortion Picketing and Mental Health: Is There a Correlation Between Picketers and Post-traumatic Stress? [06I]
Authors: Sullivan Richalle , Franklin Tanya , Bergin Ashlee 
Published: April 2020

INTRODUCTION:
Previous research has demonstrated that abortion itself doesn’t lead to long term mental health problems. There is a void in the literature in the measurement of and severity of the impact of anti-abortion picketing exposure on patients. This study aims to assess if anti-abortion picketing impacts post-traumatic stress events in patients receiving care at EMW Women’s Surgical Center in Kentucky.

METHODS:
Post-traumatic stress events were measured using the Impact of Events Scale Revised (IES-R), a validated scale that identifies the severity in which respondents experience stress related thoughts and behaviors seven days following an event. Patients seeking surgical abortions were recruited from EMW with informed consent. Participants completed a demographic survey, in which participants estimated the amount of protestors that they encountered and the level of discomfort and harassment experienced. Seven days after the procedure, participants received an email to complete the IES-R assessment, to measure post-traumatic stress events. An objective number of protestors were counted on each day of enrollment.

RESULTS:
A total of 72 participants were enrolled between October 2018 and May 2019. Twenty-five participants (35%) completed the follow-up IES-R survey. Participants who perceived larger number of protestors experienced more discomfort (P=.001) and reported more harassment (P<.001). There was no statistical difference in objective number of protestors and IES-R scores (P=.402). Participants who perceived larger amounts of protestors had significantly higher IES-R scores that met probable PTSD diagnosis (P=.040).

CONCLUSION:
This information highlights how patients’ perception of anti-abortion protestors negatively impacts the mental wellbeing of patients undergoing surgical abortions at EMW.
Comparing the Cardiovascular Risk of Norethindrone Acetate & Levonorgestrel Pills: Is There a Difference? [10I]
Authors: Barnett Clare , Bauerfeind Anja , von Stockum Sophia , Grimes David A. , Heinemann Klaas 
Published: April 2020

INTRODUCTION:
Combined oral contraceptives containing norethindrone acetate (NETA) are widely used in the US and globally, but how they compare to levonorgestrel-containing pills is unknown. This pooled analysis compares the safety of NETA and levonorgestrel (LNG) in pills with ethinyl estradiol (EE) ≤30 mcg.

METHODS:
We pooled cohorts of NETA (EE ≤30 mcg) and LNG (EE ≤30 mcg) users from four large prospective, controlled, non-interventional, cohort studies in 14 European countries, US and Canada. Baseline characteristics, including reproductive, contraceptive and medical history, were summarized using descriptive statistics. Propensity score sub-classification was applied to balance baseline characteristics between cohorts. Time-to-event analysis of venous and arterial thromboembolic events was carried out based on the extended Cox model to calculate crude and adjusted hazard ratios with 95% confidence intervals.

RESULTS:
Approximately 80,000 women contributed 145,000 women years of exposure. The prevalence of prognostic factors at baseline showed typical features of US and European oral contraceptive users. A comparison between NETA vs LNG showed no significant difference in the risk of venous thromboembolism: adjusted hazard ratio 0.73 (95% CI 0.48-1.11). A similar result was observed considering the risk of arterial thromboembolism (adjusted hazard ratio 0.89 [95% CI 0.42-1.89]).

CONCLUSION:
Low-dose oral contraceptives containing NETA and LNG are associated with similar low risks of venous and arterial disease. This analysis provides reassurance for both women and clinicians regarding the safety of contemporary oral contraceptives.
Contraception Counseling and Use Among Adolescent and Young Adult Women Undergoing Cancer Treatment [11I]
Authors: Abelman Sarah , Cron Julia 
Published: April 2020

INTRODUCTION:
Adolescent and young adult women undergoing cancer treatment face unique reproductive health risks. The objectives of this study were to assess the prevalence of pregnancy prevention counseling and contraception use in the oncology setting, and to identify patient factors associated with these outcomes.

METHODS:
After institutional review board approval, a retrospective chart review was conducted of female patients ages 15-25 receiving cancer treatment, excluding those treated with only surgery, at Yale New Haven Hospital from 2013-2018. Univariate and multivariate logistic regression were used to assess the relationship between patient variables and the outcomes of counseling and contraception use.

RESULTS:
157 patients were included in this analysis; the median age was 20, and the most common diagnoses were hematologic (40.8%) and thyroid (31.2%) malignancies. Treatments received included various combinations of surgery, chemotherapy, radiation, hormone therapy, targeted or biologic agents, and bone marrow transplant. 33.1% were documented as receiving reproductive health counseling and 48.4% used contraception. Younger patients (ages 15-20) were less likely to receive counseling (OR 0.31, 95% CI 0.14-0.70, P=.005). Receiving counseling (OR 3.36, 95% CI 1.35-8.34, P=.009) and sexual activity (OR 4.18, 95% CI 1.80-9.68, P=.001) were significantly associated with contraception use.

CONCLUSION:
Reproductive health counseling was documented infrequently during oncologic care for adolescent and young adult women, especially for younger patients. However, such conversations were associated with a higher likelihood of contraception use. There is a clear need to improve rates of counseling in this high-risk setting, especially with adolescents who may be more vulnerable when it comes to reproductive health.
Does Immediate Post-abortion Long-Acting Reversible Contraception Reduce Rates of Repeat Abortion? [14I]
Authors: Hershman Sarah R. , Reider Mitchell W. 
Published: April 2020

INTRODUCTION:
Despite overall declining abortion rates in the US, rates of repeat abortion remain high, and previous unplanned pregnancy or elective abortion are significant risk factors for future abortions. This research aims to examine whether immediate no-cost post-abortion placement of long-acting reversible contraception (LARC) is associated with decreased chance of having a repeat abortion, compared to similar patients who did not opt for immediate LARC.

METHODS:
We conducted a retrospective cohort study using records from an abortion provider where no-cost post-abortion LARC devices were available to patients. We reviewed surgical abortions between September 2015 and February 2016 (LARC cohort, n=117; no-LARC cohort, n=154), and assessed the rate at which they returned for repeat abortion at the same facility within 3 years. This study was approved by Cleveland Clinic IRB.

RESULTS:
During the 3-year rolling follow-up period, for the LARC group there were 15 patients (12.8%) returning for a total of 20 abortions, compared with the no-LARC group, who had 50 patients (32.5%) return for a total of 86 abortions. The relative risk of any repeat abortion within 3 years was 0.39 for the LARC group (95% CI 0.24–0.67).

CONCLUSION:
Immediate post-abortion LARC is associated with significantly lower rate of repeat abortion within the next 3 years. Immediate post-abortion LARC should be offered to all patients undergoing elective surgical abortion. These findings should be used to inform healthcare policy, with a goal of reducing rates of repeat elective abortion.
Exploring the Role of Medicaid as a Payer for Long-Acting Reversible Contraception in the Private-Practice Setting [17I]
Authors: Howard David L. , Ford Avery , Ceballos Sonia , Volker Warren 
Published: April 2020

INTRODUCTION:
To assess temporal trends in the role of Medicaid as a payor for intrauterine devices and contraceptive implants in the private-practice setting.

METHODS:
This was a retrospective cohort study. We studied women receiving insertions of long acting methods of reversible contraception (LARCs) between January 1, 2013, and December 31, 2016 (n=3,477 women). The exclusive data source was billing records. The setting was a large multi-specialty private practice in Las Vegas, Nevada.

RESULTS:
Between January 1, 2013, and December 31, 2016, there were 3,477 insertions of LARCs. Of this number, 400 (11.5%) were paid for by Medicaid/self-pay, and 3,077 (88.5%) were paid for by private insurance. Among LARC users 30 years and older, the proportion that had their device paid for by Medicaid/self-pay increased from 4.3% in 2013 to 12.1% in 2016 (OR 3.09 [95% CI 1.68-5.68] P<.001). The proportion paid for by Medicaid/self-pay was actually stable from 2013 to 2015 (4.3%, 3.4%, 5.5%) with a jump in 2016 (to 12.1%). Among LARC users under 30 years, the proportion that had their device paid for by Medicaid/self-pay increased from 6.0% to 26.3% over the same period (OR 5.63 [95% CI 3.35-9.49] P<.001). The increase was progressive (6.0% to 9.0% to 13.0% to 26.3%).

CONCLUSION:
In this large private-practice setting, the proportion of LARCs paid for by Medicaid increased significantly over time, particularly in women under 30 years old. We believe our findings have policy implications in the context of the current, sometimes aggressive, political attempts to roll back the expansion of Medicaid that was a crucial component of the Affordable Care Act.