bluuebunny/crossref_metadata_2025_split huggingface dataset:
Improving Screening for Intimate Partner Violence in an Ambulatory Women's Health Clinic [03F]
Authors: Pavicic Meredith , Goodman Daisy J. , Foster Tina C. 
Published: April 2020

INTRODUCTION:
The primary objective was to increase the number of women screened for IPV in an ambulatory women's health clinic.

METHODS:
This was a quality improvement project designed to increase the number of women presenting for annual visits who were screened for intimate partner violence with a validated tool. Process observations, stakeholder interviews and chart review were performed to assess baseline levels of screening and plan for implementation of a screening tool that would be useful and acceptable. Training was performed with clinic flow staff and with providers. Clinic flow staff were asked to assign a computerized screener to patients presenting for annual GYN visits with Generalist OB/GYN providers and completion of the screener was documented using a dot phrase built into the electronic medical record. Success of the intervention was assessed by recording rates of screening tool assignment, completion and documentation. Screening, completion and documentation rates over time were compared using control charts. Given lack of any validated screening tool use prior to the study period, no direct statistical comparison was made to the period prior to the study period.

RESULTS:
Of 1427 eligible women, 722 were screened (50.6%). Rates of screener assigned varied over the months assessed, with a median screening rate of 53.6% over the 10 months studied. Documentation rates also varied among providers. Median documentation rate over the study period was 85%.

CONCLUSION:
Introduction of a new screening tool led to increased rates of IPV screening over time, though further intervention is required to improve this process.
Perception of Candidates and Faculty on Maternal Fetal Medicine Fellowship Videoconference Interviewing [19G]
Authors: Nutter Anna , La Rosa Mauricio , Olson Gayle 
Published: April 2020

INTRODUCTION:
Videoconference interviewing (VCI) has been associated with efficiency, cost savings, and lack of interference with clinical responsibilities compared to traditional on-site interviews. Our objective was to evaluate the acceptability and impact of VCI for the 2018-2019 Maternal Fetal Medicine fellowship match.

METHODS:
Prior to interviews candidates were provided with a link to a power-point presentation and virtual campus tour. Candidates were interviewed by a panel of five interviewers and offered contact information for additional questions and to visit campus at their leisure. After interviews and prior to match results, an anonymous survey using a 5-point Likert scale was sent to candidates and interviewers consisting of 16 and 11 questions respectively and a comment section which queried acceptance and future feasibility of VCI. Questions similar to both groups were analyzed using Student t-test or Mann-Whitney U test.

RESULTS:
Response rate was 78% and 87% for candidates and interviewers. Candidates were all PGY4, ten female, four male and mean age 30.3 years. Candidates found the process easy (82%) and supported the concept (82%) but identified VCI prevented “gut feelings” obtained on-site. Interviewers identified the lack of subjective details from personal interaction. As a sole interview modality, 18% and 29% of candidates and interviewers identified a negative impact to the program. Questions that were similar for candidates and interviewers showed no difference in responses.

CONCLUSION:
Identified benefits of VCI included cost and time savings, but the majority of candidates preferred traditional interviews. VCI may be useful as an adjunct or screening tool for traditional on-site interviews.
Chte-Level Access to Contraception [04J]
Authors: Patel Kriya , Bakk Juliana , Pensak Meredith , DeFranco Emily 
Published: April 2020

INTRODUCTION:
To assess the influence of Medicaid on the rate of short interpregnancy intervals. We tested the hypothesis that Medicaid expansion and subsequent access to birth control would be associated with decreased short interpregnancy (IPIs) rates.

METHODS:
Using the US Birth Certificate data, we performed a population-based retrospective cohort study including all multiparous women who had a live birth in the US in 2016, after Medicaid expansion had been implemented. Multivariate logistic regression estimated the relative influence of Medicaid expansion on the outcome of short interpregnancy interval (<12 months).

RESULTS:
There were 3,956,112 live births in the US in 2016: 2,244,158 (56.7%) in multiparous women with data on IPI (n=1,077,411, 48% ME states, n=746,712, 33.3% non-ME states). The rate of short IPI was 18.1% in non-ME states compared to 16.4% in ME states, rate difference 1.68% (95% CI 1.57-1.79%). Living within a state that adopted ME was associated with a modestly decreased risk of a short interpregnancy interval (adjusted relative risk, 0.973; 95% CI 0.966-0.979), even after adjustment for coexisting risks for short IPI. The individual-level factors most strongly associated with short IPI in women who gave birth in states that did not adopt ME were black race, younger maternal age, unmarried, Medicaid enrollment and utilization of WIC, lack of early initiation of prenatal care initiation, and grand multiparity.

CONCLUSION:
The risk of short interpregnancy interval decreases with Medicaid expansion, even after adjusting for coexisting risk factors. This demonstrates the value of expanding Medicaid to women of child bearing ages.
Positive Impact of Online Education on Physicians’ Knowledge and Confidence in Prenatal Screening Methodologies [21G]
Authors: Hurst Simi , Martorano James , Capparelli Catherine , Aboulsaoud Pakinam 
Published: April 2020

INTRODUCTION:
Screening for fetal chromosomal abnormalities has become the standard of care for all pregnancies. This study assessed the ability of online continuing medical education (CME) to improve obstetricians/gynecologists (Ob/Gyns) knowledge regarding key considerations and interpretation of analyte and cell-free DNA (cfDNA) prenatal screening tests.

METHODS:
A 30-minute, CME-certified activity featuring a video-based discussion between two faculty and an associated video commentary in French (in partnership with the Collège National des Gynécologues Et Obstétriciens Français) was developed and launched online on 12/24/2018. Educational effectiveness was assessed with a repeated-pairs pre-/post-assessment study design; each individual served as his/her own control. A chi-square test assessed changes pre- to post-assessment. P values<0.05 are statistically significant. Effect sizes were evaluated using Cramer's V (<0.05 modest; 0.06-0.15 noticeable effect; 0.16-0.26 considerable effect; >0.26 extensive effect).

RESULTS:
7,603 HCPs, including 6,788 physicians have participated in the activity. This analysis comprises data from the subset of Ob/Gyns (n=831) who answered all pre-/post-assessment questions through 08/14/19. Following participation, significant improvements were observed overall (P≤.0001, V=.140) and in the following areas: Identifying possible causes for a no-call result (61% pre vs 75% post; 23% relative improvement; P<.0001; V=.144). Recognizing the rationale for screening all pregnancies vs just high-risk pregnancies (61% pre vs 75% post; 21% relative improvement; P<.0001; V=.135). 41% Ob/Gyns reported measurable increases in their ability to interpret cfDNA test results.

CONCLUSION:
This educational activity significantly improved Ob/Gyn’s knowledge of clinical considerations when performing prenatal screening as well as key differentiating characteristics of analyte and cfDNA screening tests.
Provider Selection: Patient Turnover Occurs Nearly Half the Time in Subsequent Pregnancies [22G]
Authors: Bradley Danielle , Blaine Arianna , Wolfberg Adam 
Published: April 2020

INTRODUCTION:
The objectives of this study were to understand 1) how common it is to change providers between pregnancies, 2) which sources of information patients use when selecting their provider, and 3) which factors matter most when selecting a provider.

METHODS:
A survey about provider satisfaction and selection was sent to users of the Ovia Pregnancy mobile app. Respondents were age 18 or older, United States residents, and pregnant (n=2,142). IRB exemption was granted.

RESULTS:
Among respondents, 979 (46%) were multiparous, of which 437 (45%) reported seeing a different provider during this pregnancy, compared to their previous pregnancy. The most commonly reported reason was geography — either the provider or patient relocated (38%). A combined 34% reported their previous provider being a bad fit or having had a negative experience. Nulliparous women (n=1,163) and multiparous women who kept their same provider (n=542) reported recommendations from friends/family members as the most common influence in provider selection (54% in both groups). Multiparous women who changed their provider depended on recommendations and internet searches most often (47% and 46%, respectively). In-network, ratings and reviews, recommendations, proximity to home/work, and scheduling ease were the five most important factors when selecting a provider among all three groups of women.

CONCLUSION:
Results indicate that patient turnover is common and some causes of this turnover are preventable. With continuity of care being an important aspect of preconception, perinatal, and postpartum health, this degree of patient turnover should be addressed.
Providers Perspectives on Racial Equity: What Is Needed in a Training to Advance Black Women’s Reproductive Health [23G]
Authors: Chambers Brittany D. , Taylor Brianne , Nelson Tamara , Harrison Jessica , Bell Arielle , Scott Karen A. 
Published: April 2020

INTRODUCTION:
To explore providers’ perceptions of the need for a racial equity training and recommendations on strategies that can be used to improve black women’s reproductive health outcomes.

METHODS:
January-March 2019 we conducted 25 semi-structured interviews (30-60 minutes) with a diverse group of prenatal care providers practicing in the San Francisco Bay Area. Providers were recruited through email correspondences and department meetings. Culturally concordant qualitatively trained researcher assistants conducted all interviews. Interviews were audio-recorded and transcribed. We used the constant comparative method to analyze data. This study was approved by the University of California, San Francisco Institutional Review Board.

RESULTS:
Most providers were CNM (n=8, 32%) or OB/GYN (n=7, 28%), worked in their current role for 1-5 years (n=10, 40%), and identified as white (n=16, 64%). All providers expressed a need and importance to address racial inequities to improve the care experiences and reproductive health outcomes of black women. Most providers agreed that the proposed components of the racial equity training were important topics to cover: Racism in the US (n=20, 80%), Racial Disparities in Maternal and Neonatal Outcomes (n=23, 92%), Women’s Experiences, (n=24, 96%), Providers’ Experiences (n=16, 64%), and Reflection and Discussion (n=18, 72%). Providers stressed that there is need for an action-oriented racial equity training where they learn how to address racism as well as implement system-level accountabilities (e.g., metrics on patients’ perceptions of care).

CONCLUSION:
Providers desire an action-oriented racial equity training that will provide ongoing skills and practice, and system-level accountabilities to better serve black women.
Twitter and Obstetrics and Gynecology: Where Do the Chirps Stand? A Review of the Literature and Social Media [27G]
Authors: Noureddine Lama , Chappelle Joseph 
Published: April 2020

INTRODUCTION:
The media has played an increasing role in medicine in recent years and social media has proven to have an influential power over the public. Physicians, in general, are late adopters of new technology which can lead to the loudest voices being non-professionals.

METHODS:
A search was conducted on Twitter using the keywords “obgyn” and “obstetrics and gynecology” between the dates of September 1st, 2019 and September 30th, 2019. Tweets were classified as posted by medical professionals vs non-professional, and goal of tweet: education, opinion, personal or public announcement.

RESULTS:
A total of 198 tweets are identified. The majority (55.5%) of tweets are posted by non-professional users. The most common category is opinion (40.4%) and the least common is educational (19.2%). Among professional voices 14.9% were opinion tweets and 38.3% were educational tweets. In contrast, among non-professional posts, 85.6% of the posts were opinions while 9.2% were educational.

CONCLUSION:
Social media is a powerful method for interacting with the public. Medical professionals have an opportunity to drive the conversation. We also can provide a higher ratio of education to opinion in order to increase awareness to the public.
Understanding the Second Victim Experience Among Multidisciplinary Providers in OB/GYN [28G]
Authors: Rivera-Chiauzzi Enid , Riggan Kirsten , Long Margaret E. , Allyse Megan A. , Torbenson Vanessa , Weaver Amy 
Published: April 2020

INTRODUCTION:
Adverse patient events inevitably occur in OB/GYN practice. Health care provider who are “second victims” experience psychological trauma and progress through defined stages of recovery as they process the event. This experience is believed to be an under-recognized, yet prevalent phenomenon. Study aims were to determine the prevalence of second victims and the risk factors for feeling like a second victim among staff caring for OB/GYN patients to guide the implementation of new resources for second victims.

METHODS:
We administered the validated Second Victim Experience and Support Tool (SVEST) supplemented with non-validated questions to multidisciplinary team members caring for OB/GYN patients at Mayo Clinic in Rochester, MN. Respondents to the self-administered, anonymous survey included physicians, nurse practitioners, physician assistants, certified nurse midwife, registered nurses, allied health professionals, and desk staff.

RESULTS:
The survey was completed by 205 staff (117 OB only, 73 GYN only, 15 both). During their career, 44.8% felt like a second victim while 18.8% had this experience in the last 12 months. Residents and fellows had the highest percentage of second victims (41.7%). Respondents who reported greater psychological distress were more likely to report that they felt like a second victim after an adverse patient safety event within the preceding 12 months (p-value<0.001). The same finding was observed for measures of physical distress.

CONCLUSION:
OB/GYN team members report significant differences in physiological and physical symptoms after adverse events. Understanding and screening for psychological and physical symptoms may be useful in identifying second victims and guiding support following adverse events.
What Are We Learning? An Update on Abortion Education in Medical Schools [29G]
Authors: Heger Julie , Roth Joeli , Kenya Sonjiya 
Published: April 2020

INTRODUCTION:
Nearly one in four U.S. women will have an abortion by age 40, making abortion one of the most common medical procedures women undergo in the United States. Despite its prevalence, abortion education has been historically limited in United States (US) medical schools’ curricula. The last assessment of medical schools' reproductive health curricula was done in 2005. This research aims to reexamine the status of abortion education.

METHODS:
We emailed a three-question survey to the Obstetrics & Gynecology clerkship directors at 143 US allopathic medical schools. The survey assessed the availability and type of reproductive health exposure students have during their pre-clinical and clinical years. Participants were invited to complete the survey in April, and reminder emails with the survey link were sent in July and September.

RESULTS:
Thus far, 79 clerkship directors have responded to the survey, for a response rate of 56%. Ten percent of clerkship directors reported no formal abortion education in preclinical or clinical years. This is compared to 2005, with 17% of clerkship directors indicating no formal abortion education. In the clinical years, 47% of respondents indicated abortion education was integrated into the experience, while 28% reported students had to arrange participation on their own.

CONCLUSION:
While there has been some increase in the availability of abortion education in U.S. medical schools, this improvement pales in comparison to the national demand for the procedure. As a fundamental aspect of reproductive health, abortion education deserves a place in the curricula at every medical school.
ZIP Codes Affected by Hurricane Harvey in Proximity to Superfund Sites and Impacts to Maternal and Neonatal Morbidity [30G]
Authors: Hanson Frances K. , Aagaard Kjersti , Suter Melissa 
Published: April 2020

INTRODUCTION:
A time series (TS) analysis before and after Hurricane Harvey to understand the impact of flooding and proximity to Texas Superfund sites on composite maternal (CMM) and neonatal morbidity (CNM) in affected region.

METHODS:
A population-based cohort was used to select gravidae delivering within a fixed two-year time interval before and after Harvey, and analyzed by proximity to 11 Superfund sites in the region. CMM included: hypertensive disorder of pregnancy, chorioamnionitis, endometritis, blood transfusion, peripartum hysterectomy, maternal ICU admission, pulmonary edema or maternal death. CNM included: 5-minute Apgar score ≤ 3, respiratory distress syndrome, use of ventilatory/CPAP, suspected newborn sepsis, seizure, stillbirth, or neonatal death. CMM and CNM were aggregated across ZIP codes and mapped alongside regional Superfund sites using GIS. A TS assessment of the spatial relationship between ZIP codes and their proximity to the Superfund sites before and after Harvey was performed.

RESULTS:
Affected ZIP codes saw an increased hotspot CMM by 16% before and 4% after Harvey when compared to all regional ZIP codes. The affected ZIP codes saw an increased hotspot CNM by 12% before and a decrease of 6.67% after Harvey when compared to regional ZIP codes. The TS assessment showed a decrease in hotspot CMM by 17.2% in affected ZIP codes. The hotspot CNM among affected ZIP codes decreased by 66.67%.

CONCLUSION:
The decrease in hotspot morbidity for both CMM and CNM after Harvey unveils the substantial impact of three significant flooding events that occurred within the region in the two years inclusive of Harvey.
Can We Harness the Business Paradigm of Value Creation to Support Quality Improvement Projects? [31G]
Authors: Paek Bettina , Walker Martin 
Published: April 2020

INTRODUCTION:
Quality improvement projects are generally not reimbursed by payers and often rely on engaged staff and physician volunteers. Physicians typically receive no training in business strategy. We hypothesized that adopting a paradigm of value creation has the potential to support QI projects and thereby enhance patient outcomes in a financially sustainable way.

METHODS:
Childbirth is the most common indication for hospital admission in the US. We identified pain points for insurance companies and hospitals that coincided with existing quality improvement initiatives. A decrease in the cesarean rate was chosen as a potentially modifiable target that would create a compelling value proposition for payers. A labor support app was then designed with content curated to support a QI initiative to decrease the NTSV cesarean rate. A business plan was built around the app and tested for viability in the investor community, with hospital administrators, insurance- and employer representatives.

RESULTS:
We partnered with Penny Simkin, to provide labor support content. Labor support has been shown to decrease cesarean birth. The app format allows for easy access by patients and their care team. Every cesarean avoided results in cost savings for payers, favoring payment of the app. This was highly acceptable to hospitals administrators, insurance and employer representatives. The business plan won first place in the business plan competition, indicating a high level of support of the local business community.

CONCLUSION:
Approaching clinical problems with a perspective of value creation to payers has the potential to create financially viable solutions and improve care for our patients.
Determining the Impact of Journal Abstract Structure and Word Limit on the Completeness of Study Reporting [32G]
Authors: Freedman Lesle , D'Souza Rohan D. , Nica Alex , Huszti Ella 
Published: April 2020

INTRODUCTION:
It is vital that journal abstracts, which summarize clinical research, contain sufficient information on the study, for readers to draw appropriate conclusions. Our study examined the influence of variations in abstract structure and maximum word limit among obstetrics and gynecology (OBGYN) journals on the completeness of study reporting.

METHODS:
We conducted a retrospective study examining 163 abstracts from 50 OBGYN journals using a modified, 32-item, version of a previously-published checklist for abstract assessment. Abstracts were classified into three groups based on abstract structure – unstructured, structured-with-headings and structured-without-headings, and three based on word count – less-than-250, 250- and greater-than-250 words. Based on preliminary assessment of abstracts, which scored 37-78% on the checklist, we determined that we needed 140 abstracts to determine differences between groups, with 80% power. Primary outcome was abstract quality score. ANOVA and linear regression analysis were used to determine whether abstract structures and word limits were associated with journal abstract quality.

RESULTS:
A significant difference in mean abstract scores were found for word limit (P=.012) but not abstract structure (P>.05). Mean score of the greater-than-250-word and 250-word category were significantly higher than those of the less-than-250-word category (68.25 vs 59.69, P=.003 and 65.20 vs 59.69, P=.046 respectively).

CONCLUSION:
Although abstract structure does not seem to influence quality, OBGYN journal abstracts with less-than-250-words might exclude important study information. Research on other factors influencing abstract quality could help journals improve the appropriate condensation of study information into abstracts, which are most widely read and often used to guide busy clinicians.