bluuebunny/crossref_metadata_2025_split huggingface dataset:
Increasing Equity in Tdap Vaccination in Pregnancy: Using Data to Drive a Quality Improvement Project [15F]
Authors: Lalla Amber , Leyba Katarina , Stonehocker Jody , Martinez Melissa 
Published: April 2020

INTRODUCTION:
National guidelines recommend the Tdap vaccine during 27-36 weeks gestation to confer immunity to the neonate. At the University of New Mexico, Title V-funded clinics that provide prenatal care for uninsured women do not provide on-site Tdap, but refer women to the Department of Health (DOH) for vaccination. Other university clinics stock the vaccine on-site. We sought to compare rates at Title V clinics to university-based obstetrical and family medicine clinics.

METHODS:
A retrospective review of electronic health records was performed for women who received prenatal care at Title V, obstetric, and family medicine clinics in 2018. Patients were crossed checked in the New Mexico Statewide Immunization Information System to include DOH records. Statistical significance was assessed using two-sample tests of proportion and a logistic regression.

RESULTS:
Results from 372 charts revealed the rate for Title V clinics (31.94%) was significantly lower than the rates for obstetrical clinics (71.91%, P<.02) and family medicine clinics (90%, P<.001). Controlling for demographic factors, women at Title V clinics were 80% less likely to get a Tdap vaccine than women who went to obstetric clinics (P<.001).

CONCLUSION:
Title V clinic patients are less likely to receive Tdap than patients who receive care at clinics with Tdap on-site. Providing on-site Tdap vaccination for uninsured pregnant women is a matter of health equity. Advocating for change by addressing specific barriers is ongoing. The results of this study have guided a comprehensive quality improvement project, resulted in the donation of on-site vaccines, and inspired a larger DOH study.
Pneumococcal Vaccines in Pregnancy: Understanding Indications and Knowledge Gaps [22F]
Authors: DeGrio Angela , Erickson Laurie P. 
Published: April 2020

INTRODUCTION:
The Center for Disease Control and Advisory Committee on Immunization Practices recommends the pneumococcal vaccine for patients with specific medical comorbidities. Many obstetric patients qualify for the vaccination and the prenatal period provides an ideal opportunity for intervention. The primary objective of this study was to determine how many patients are potential candidates to receive the vaccine series, and secondarily, to assess resident knowledge.

METHODS:
A retrospective chart review was performed of women receiving prenatal care at an academic ambulatory clinic between 12/2016-12/2017 to determine the number of patients who met criteria for the pneumococcal vaccine. A survey was administered to residents to evaluate the level of confidence surrounding immunization recommendations and prescribing patterns.

RESULTS:
Of the 302 patients who presented for OB care during the study period, 24% met criteria for the pneumococcal vaccine (75/302). The top three qualifying criteria were smoking (33), asthma (20), and diabetes (11). Two patients were diagnosed with upper respiratory tract infections that required antibiotics, and there were no cases of pneumonia. The immunization rate for influenza and Tdap vaccines were 55% and 69% respectively. Residents in the survey expressed a comfort level of 6.5/10 with understanding prenatal vaccine recommendations, 3.8/10 for comfort level of understanding candidates for the pneumococcal vaccines.

CONCLUSION:
A significant number of obstetric patients are candidates for the pneumococcal vaccine. Residents self-identify a gap in knowledge surrounding recommendations for this vaccine series.
Battling Maternal Mortality Through Access to Primary Care Physicians [26F]
Authors: Yadav Ghanshyam S. , Angraal Suveen , Turrentine Mark , Nagarkatti Nupur 
Published: April 2020

INTRODUCTION:
Chronic disease among reproductive aged women has been implicated as one of the reasons for the high maternal mortality rate in the United States. Primary care physicians (PCPs) play a vital role in maintaining life-long health and in management of chronic diseases. We evaluated the association between prevalence of PCPs and maternal mortality rates.

METHODS:
County-level data on number of PCP’s and maternal mortality rates in 2014 was obtained from the American Medical Association and National Vital Statistics System, respectively. County level population metrics from the Census Bureau were used to estimate the number of PCPs per 100,000 population. Linear regression model was used to assess association of PCP rate with county-level age-standardized maternal mortality rates. Furthermore, we compared counties with no PCPs, with an equivalent number of counties with highest rate of PCPs. Relative risk reduction for maternal mortality was calculated.

RESULTS:
Data were available for 3069 (97.6%) counties. National maternal mortality rate (per 100,000 population) in 2014 was 0.35 (95% CI 0.33–0.37). At the county level, number of PCPs per 100,000 was negatively associated with maternal mortality rate after adjusting for various socio-demographic factors (P<.001). 149 counties in the United States had no PCPs. When compared with 149 counties with highest number of PCPs per 100,000 population, the maternal mortality rate was significantly higher (0.36 versus 0.28, respectively P<.01).

CONCLUSION:
Higher maternal mortality rates are noted in counties with a lower prevalence of PCP’s. Improving access to PCPs may reduce maternal mortality rates in the United States.
Standardization of Care Following a Positive Behavioral Health Screen in Pregnancy [32F]
Authors: Dean Sara M. , Jackson Aimee , Denning Stacie , Gandhi Manisha 
Published: April 2020

INTRODUCTION:
Provider bias plagues behavioral health screening in pregnancy. One in three pregnant women will utilize illicit substances, experience depression/anxiety, or be a victim of violence. Following our Phase I results presented in 2019, we aimed to develop a standardized algorithm for providers to guide response to positive behavioral health screens.

METHODS:
Through an IRB approved protocol, we screened 260 patients at three intervals during pregnancy between January and June 2019. Patients in a Maternal Fetal Medicine clinic voluntarily completed the Integrated Screening Tool at three separate encounters. A novel, evidence-based algorithm was developed and utilized to guide provider response to a positive screen.

RESULTS:
During the study period, 479 eligible screening visits occurred among 260 patients. Compared to Phase I, indicated urine drug screen (UDS) completion increased from 13% to 80% (P<.001), of which 11% were positive. Across the screening intervals, 65% of patients with an initial positive screen, subsequently answered negative. Of the patients who initially screened negative, 25% had a positive screen later in pregnancy, of which 33% UDS were positive. Referral to mental health services for patients with a positive emotional health screen increased by 100% following implementation of the algorithm (P<.002).

CONCLUSION:
Utilizing a standardized algorithm guiding provider response to behavioral health screening in pregnancy significantly increased provider action yet did not identify a significant increase in detecting patients using illicit substances. Longitudinal screening is important as patients are likely to change their response. Additional study is indicated to further establish validity of this novel algorithm.
The Patient Perspective on the HPV Vaccine and Its Recently Expanded Coverage [33F]
Authors: Caja Madison , Hashmi Mahreen 
Published: April 2020

INTRODUCTION:
The objective of this study is to explore the patient understanding of HPV and its vaccine and to ascertain any pertinent biases. The human papilloma virus (HPV) vaccine was recently FDA approved to extend coverage to age 45 instead of age 26. The vaccine is recommended by ACOG for males and females aged 9-45.

METHODS:
Between April and June 2019, patients of WVU Medicine OBGYN completed a one-time survey at their well-woman examination. The survey was created to assess associations between socioeconomic variables, sexual history, and the patient perception of the HPV virus and vaccine.

RESULTS:
A total of 200 women participated. The average age was 45 with most currently sexually active (84%). While most women reported that they were in support of vaccines (95%), the majority of women without a previous HPV vaccination reported they were not interested in receiving the vaccine themselves (48%) but were more likely to be in favor to vaccinate their sons (57%). It should be noted 0 women reported all of the correct cancers associated with HPV with only 7 women reporting the association with head and neck cancers. Almost a quarter of women (21%) incorrectly believed HPV had links to uterine and ovarian cancer.

CONCLUSION:
There are visible gaps regarding HPV and its vaccine. A major gap is the paucity of knowledge of the types of cancers HPV can cause. Physicians can recognize potential candidates and implement more education within the well-woman visit to make sure women are well-informed about HPV and the vaccine.
Healthcare Providers as Fertility Information Sources for Cis Heterosexual Women and LGBTQ+ Individuals [15G]
Authors: Worthington Amber , Shirazi Talia , Abrams Mere , Burke Erin , Leahy Carly 
Published: April 2020

INTRODUCTION:
Healthcare providers are important sources of fertility information; however, all individuals may not have access to or feel comfortable communicating with providers about fertility. We evaluated current and preferred sources of fertility information, as well as efficacy to communicate with providers about fertility in cis heterosexual women and LGBTQ+ individuals.

METHODS:
Participants (N=514) included cis heterosexual women (n=311) and LGBTQ+ individuals (n=203). The data were gathered using a 2019 IRB-approved online survey and analyzed using descriptive statistics and independent sample t-tests.

RESULTS:
Cis heterosexual women’s top current fertility information sources included general providers (59.8%) and health-focused websites (46.9%); cis heterosexual women would prefer general providers (73.3%) and specialists (57.6%). LGBTQ+ individuals’ top current fertility information sources included health-focused websites (43.8%) and social media (33.5%); LGBTQ+ individuals would prefer general providers (70.4%) and specialists (51.2%). Cis heterosexual women (M=3.94, SD 0.79) had higher efficacy to communicate with providers about fertility than LGBTQ+ individuals (M=3.19, SD 1.12; t(331.57)=8.28***). (***P<.001).

CONCLUSION:
We found that providers are preferred sources of fertility information for cis heterosexual women and LGBTQ+ individuals, and LGBTQ+ individuals are less comfortable communicating with providers about fertility. To facilitate all individuals’ abilities to achieve their reproductive and family planning goals, providers should be aware that they are preferred sources of fertility information for cis heterosexual women and LGBTQ+ individuals and should create an inclusive environment for LGBTQ+ communication about fertility.
Alkaline Phosphatase Levels in Pregnancy and Its Association With Birth Weight: Prospective Cohort [03O]
Authors: Lambers Donna , Schadler Brittny , Devaiah Ganga , Thomas Megan 
Published: April 2020

INTRODUCTION:
Alkaline phosphatase (ALP) is produced by placental syncytiotrophoblasts and levels are normally increased in pregnancy. The aim was to determine if total ALP level between 24–28 weeks could be used as a screening tool in healthy singleton pregnancies as a predictor for low birth weight.

METHODS:
An IRB approved prospective study with total ALP serum levels collected from women with a singleton pregnancy between 24–28 weeks gestation. Pregnancies complicated by conditions that could affect ALP levels or fetal growth were ineligible. Pregnancy and birth data was abstracted from the patient's chart. Infants were classified as SGA, AGA and LGA by gestational age at birth and gender.

RESULTS:
255 patients had complete ALP level and delivery outcome data. There were no statistically significant differences in baseline maternal demographic characteristics noted between groups. Mean gestational age at delivery was 39.1 weeks. ALP levels in the SGA group, 83 (±35) IU/L, were not significantly higher when compared to the AGA group, 69 (±21) (P=.062), and LGA group was 78 (± 21) IU/L. Mean birth weights for SGA, AGA and LGA were 2609 (±282), 3247 (±486), and 4118 (±290) gm. Mothers of SGA infants had lower GCT results at 94.9 (±23.4) mg/dL as compared to mothers of AGA infants 107.6 (±25.5), P=.016. Patients who developed gestational hypertension were more likely to have ALP levels >75th% (P=.002).

CONCLUSION:
There was only a weak association noted between ALP levels at 24 to 28 weeks gestation in healthy singleton pregnancies and birthweight. Therefore, ALP performs poorly as a way to screen for SGA growth in newborns.
Fetal Bradycardia in Response to Maternal Hypothermia [15O]
Authors: Spires Benjamin , Towers Craig V. 
Published: April 2020

INTRODUCTION:
Fetal bradycardia, especially if it develops abruptly in the setting of a normal fetal heart (FHR) tracing, is most often associated with fetal compromise. The differential diagnosis may include numerous maternal, placental, and fetal conditions that would prompt emergent delivery. These causes are usually associated with an absence of FHR accelerations and decreased or absent variability. On the other end of the spectrum, fetal tachycardia also has numerous causes, one of which is maternal fever (or hyperthermia). Therefore, it is plausible that the opposite effect of a low maternal temperature or hypothermia might produce fetal bradycardia. The purpose of this case series is to demonstrate this finding.

METHODS:
6 cases of fetal bradycardia associated with maternal hypothermia were collected. Data collection included gestational age at presentation, maternal medical condition, maternal temperature, FHR baseline, presence and/or absence of FHR variability and accelerations, and pregnancy outcome.

RESULTS:
All 6 cases demonstrated FHR baselines in the 80–90s in the setting of maternal hypothermia. Maternal temperatures ranged from 92.1–96.9 0F. All had moderate variability with the presence of accelerations. All FHR baselines returned to normal with correction of maternal temperature. No adverse outcomes were seen in the 6 neonates post-delivery.

CONCLUSION:
These cases demonstrated fetal bradycardia can be seen in the presence of maternal hypothermia. The appearance of the FHR tracing is reassuring, except for the baseline. Therefore, emergent delivery is not indicated. The FHR baseline returns to normal with correction of maternal temperature. The overall clinical picture should be taken into consideration before proceeding with delivery.
Treating postpartum depression with brexanolone
Authors: Burval Jessica , Kerns Rachel , Reed Kim 
Published: April 2020

Abstract:
The FDA has approved brexanolone specifically for treatment of adults with postpartum depression (PPD). Administered I.V., it can relieve severe signs and symptoms of PPD within days rather than weeks. This article discusses the benefits and risks of brexanolone as a treatment for PPD, including nursing considerations and patient teaching.
Anatomical Variability Predisposed a Child to Permanent Brachial Plexopathy following Incidental Trauma
Authors: Sharif-Askary Banafsheh , Mantilla-Rivas Esperanza , Mamidi Ishwarya , Talbet Joseph , Manrique Monica , Aivaz Marudeen , Keating Robert F. , Oh Albert K. , Rogers Gary F. 
Published: April 2020

Summary:
Anatomic variations in peripheral nerves and the perineural environment are common and can contribute to acute or chronic neuropathy in certain individuals. Awareness of these variants is relevant to understanding both the etiopathogenesis and the increased susceptibility to nerve injury in some patients. We present a 4-year-old boy who sustained a permanent injury to the upper brachial plexus from a relatively minor trauma. Surgical exploration revealed a variation in upper trunk anatomy that likely contributed to this outcome.
PURTSCHER'S‒LIKE RETINOPATHY SECONDARY TO GRANULOMATOSIS WITH POLYANGIITIS FOLLOWING AUTOLOGOUS STEM CELL TRANSPLANTATION
Authors: Hupy Matthew L. , Pecen Paula E. , Kolfenbach Jason R. , Lau Marissa , Palestine Alan G. 
Published: April 2020

Purpose:
The authors describe a man undergoing autologous stem cell transplant, who developed granulomatosis with polyangiitis and Purtscher's‒like retinopathy.

Methods:
A 25-year-old man underwent fundus photography, optical coherence tomography, and fluorescein angiography to obtain a diagnosis and follow the treatment course.

Results:
The initial ophthalmic presentation and imaging confirmed the findings of Purtscher's‒like retinopathy. Throughout his course, he had progressive neovascularization and vitreous hemorrhages in both eyes, requiring vitrectomy and endolaser, and bevacizumab injections.

Conclusion:
The authors describe a patient who underwent autologous stem cell transplantation, and subsequently developed granulomatosis with polyangiitis. The presentation of Purtscher's‒like retinopathy suggests that microvascular occlusion in the retina was likely the result of granulomatosis with polyangiitis-driven vasculitis of the precapillary arterioles.
RE-KINECT
Authors: Caroff Stanley N. , Yeomans Karen , Lenderking William R. , Cutler Andrew J. , Tanner Caroline M. , Shalhoub Huda , Pagé Véronique , Chen Jun , Franey Ericha , Yonan Chuck 
Published: April 2020

Abstract

Purpose/Background
RE-KINECT (NCT03062033) was designed to assess the presence and impact of possible tardive dyskinesia (TD) in antipsychotic-treated outpatients.

Methods/Procedures
The study included adults with 3 or more months of lifetime antipsychotic exposure and 1 or more psychiatric disorder. Based on clinician observation and assessment, patients were assigned to cohort 1 (without involuntary movements or with non-TD involuntary movements) or cohort 2 (with involuntary movements confirmed by clinician as possible TD). Baseline assessments included the following: patient characteristics; location/severity of involuntary movements; and impact of possible TD on health-related quality of life, including the EuroQoL 5-Dimensions 5-Level questionnaire.

Findings/Results
Of 739 eligible patients, 204 (27.6%) had clinician-confirmed possible TD (cohort 2). Compared with cohort 1, patients in cohort 2 were significantly older (P < 0.0001), more likely to have schizophrenia or schizoaffective disorder (P < 0.0001) and longer lifetime exposure to antipsychotics (P < 0.0001), and less likely to be working or studying, based on clinician perception (P = 0.0010). Clinician- and patient-rated severity of possible TD movements was significantly correlated in each of 4 body regions (head/face, neck/trunk, upper extremities, lower extremities), for maximum severity in any region, and for total number of affected regions (P < 0.001 for all correlations). For the patient-rated EuroQoL 5-Dimensions 5-Level, the health state visual analog scale score was significantly lower (worse) in cohort 2 versus cohort 1 (66.8 vs 69.7; P = 0.0002), as was the utility index score (0.71 vs 0.76; P < 0.0175).

Implications/Conclusions
Results from this real-world population indicate that TD occurs frequently and can significantly reduce quality of life in patients with a psychiatric disorder.
A preliminary study on submariners with xerostomia after a 3-month deployment
Authors: Wang Guowei , Zhao Baodong , Kong Yujia , Ma DeXun , Yang Lin , Song Yingliang , Wang Xiaojing 
Published: April 2020

Abstract
To observe the clinical manifestations and salivary secretion of xerostomia patients in submariners who engaged in a three-month deployment. The general conditions and clinical examination of the 136 submariners were evaluated, by which the patients with xerostomia were screened out and their clinical manifestations were recorded. Besides, the flow rate of unstimulated saliva and stimulated saliva was measured and calculated. Subsequently, the related factors of xerostomia were quantitatively classified and statistically analyzed. In all the involved submariners, 42 were diagnosed to have xerostomia by physical examination after they returned from the task, among which 71.4% showed a decrease in unstimulated salivary flow rate and it was significantly correlated with the accompanying symptoms and their general conditions. Therefore, it was concluded that the occurrence of xerostomia could be related to the service life and job responsibilities of the submariners. The main manifestations were the reduction of unstimulated salivary secretion and the accompanying clinical symptoms such as cheilosis and angular cheilitis. Noticeably, the high psychological pressure and harsh living conditions need to be concerned, and further study should place more concentrations on these comprehensive influence factors and preventive actions of xerostomia.
Association between hypothyroidism and chronic kidney disease observed among an adult population 55 years and older
Authors: Huang Cheng-Wei , Li Bonnie H. , Reynolds Kristi , Jacobsen Steven J. , Rhee Connie M. , Sim John J. 
Published: April 2020

Abstract
Hypothyroidism and chronic kidney disease (CKD) are highly prevalent conditions with a potential mechanistic link. We sought to determine whether hypothyroidism is associated with CKD among a large diverse community-based cohort.
A cross-sectional study was performed (January 1, 1990–December 31, 2017) within a large integrated health system. Individuals age ≥55 years of age with outpatient measurements of thyroid stimulating hormone (TSH) and ≥2 serum creatinine values were included. Hypothyroidism was defined as TSH >4 mIU/L and/or receipt of thyroid hormone replacement and further categorized as hypothyroid status: TSH >4 mcIU/mL and attenuated-hypothyroid status: TSH <4 mcIU/mL with receipt of thyroid hormone replacement. Euthyroidism was defined as TSH <4 mIU/L and no thyroid hormone replacement. Our primary measure was CKD defined as an estimated glomerular filtration rate (eGFR) <45 mL/min/1.73 m2. Multivariable logistic regression adjusting for age, sex, race, and comorbidities was used to estimate odds ratios (OR) for CKD by thyroid status.
Among 378,101 individuals, 114,872 (30.4%) had hypothyroidism among whom 31,242 and 83,630 had hypothyroid and attenuated-hypothyroid statuses, respectively. Individuals with hypothyroidism had a CKD OR (95%CI) of 1.25 (1.21–1.29) compared with those with euthyroidism. Granular examination of thyroid statuses showed that hypothyroid and attenuated-hypothyroid statuses had CKD ORs (95% CI) of 1.59 (1.52–1.66) and 1.12 (1.08–1.16), respectively. A similar relationship was observed in analyses that defined CKD as an eGFR <60 L/min/1.73 m2.
Among individuals 55 years and older, we observed that those with hypothyroidism were more likely to have CKD. A stronger association was found among patients of hypothyroid status compared with attenuated-hypothyroid status suggesting a dose dependent relationship.