bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of E2/P4 Oral Capsules on Bone Turnover in Women With Vasomotor Symptoms [06F]
Authors: Kagan Risa , McClung Michael R. , Graham Shelli , Bernick Brian , Mirkin Sebastian , Constantine Ginger 
Published: April 2020

INTRODUCTION:
Menopausal hormone therapy slows bone turnover and reduces the risk of osteoporotic fractures. The objective of this post hoc analysis was to evaluate bone turnover markers (BTM) in the phase 3 REPLENISH trial, which evaluated vasomotor symptoms (VMS) with an oral estradiol/progesterone (E2/P4) in postmenopausal women with a uterus.

METHODS:
Eligible women for this analysis had ≥50 moderate to severe VMS/week, <5 years since last menstrual period, and BTM measurements at baseline, and months 6 and 12. Percent changes for 3 BTM (bone specific alkaline phosphatase [BSAP], C-terminal telopeptide of type I collagen [CTX-1], and N-terminal propeptide of type I procollagen [PINP]) assessed by immunoassay methods were evaluated from baseline to months 6 and 12 for the 1/100, 0.5/100 and placebo groups.

RESULTS:
A total of 157 women (40-61 years, 69% white) were analyzed (56 for each 1/100 and 0.5/100; 45 for placebo). Mean baseline values ranged from 14.0-14.3 U/L for BSAP, 0.34-0.39 ng/mL for CTX-1, and 76.9-79.3 ng/mL for PINP. Mean differences in percent change from baseline versus placebo significantly decreased with both E2/P4 doses for all 3 BTM at months 6 and 12. Mean differences from placebo for E2/P4 at months 6/12 ranged from -8.1% to -17.8% for BSAP (all, P≤0.02), -30% to -41% for CTX-1 (all, P≤0.001), and -14% to -29% for PINP (all, P≤0.007).

CONCLUSION:
REPLENISH data provide support for a potential skeletal benefit of E2/P4 when used for the treatment of moderate to severe VMS.
Anxiety and Pain in Patients Undergoing Pipelle Endometrial Biopsy: A Prospective Study [11F]
Authors: Adambekov Shalkar , Lopa Samia , Edwards Robert P. , Bovbjerg Dana H. , Linkov Faina , Donnellan Nicole 
Published: April 2020

INTRODUCTION:
Pipelle biopsy is a minimally invasive endometrial sampling procedure, important for early diagnosis of endometrial pathology and treatment planning. While generally well tolerated, some women experience considerable pain. The prospective study reported here provides a first critical test of the hypothesis that heightened anxiety may contribute to the risk of severe pain in women undergoing Pipelle biopsy.

METHODS:
Pain and anxiety levels immediately prior to, during, and after the Pipelle biopsy were assessed (0-10 numeric rating) in a sample (n=113) of consecutively recruited women undergoing outpatient Pipelle biopsies in a tertiary care facility. Personal and clinical data were extracted from medical records and from surveys administered to providers. Multivariable logistic regression models and generalized estimating equations examined associations between severe (≥7) pain and anxiety prior to, during, and after the biopsy.

RESULTS:
Severe pain was reported by 9%, 43%, and 13% of participants prior to, during and after the procedure (respectively), while severe anxiety was reported by 30%, 38% and 12%. Pain was significantly associated with anxiety levels at all times assessed. Adjusting for covariates (e.g., age, BMI, biopsy indication), the odds of severe pain prior to, during, and after biopsy were 5.9, 2.3, and 11.0 times higher (respectively) for patients with severe anxiety prior to the procedure.

CONCLUSION:
The strong relationships between anxiety prior to Pipelle biopsy and patients’ experiences of severe pain associated with the procedure suggest that interventions aimed at reducing anxiety might substantially improve the patient experience of this widely-used procedure for endometrial biopsy.
High-Risk Pregnancies and Health Conditions in Medicaid-Insured Participants in a Federal Healthy Start Program [13F]
Authors: Roman Lee Anne , Strutz Kelly , Luo Zhehui , Johnson Melinda , Meulen Peggy Vander , Meghea Cristian 
Published: April 2020

INTRODUCTION:
Decreasing disparities in maternal morbidity and mortality and addressing maternal chronic health conditions in Medicaid-insured pregnant women are important national goals. Federal Healthy Start (HS) programs provide care for underserved and racial/ethnic minority women, many with self-reported medical conditions, and address social determinants; an opportunity for strategic partnerships with clinical providers. The study objective was to use administrative data and describe health conditions and compare risks in a cohort of HS participants with a statewide population of Medicaid-insured women.

METHODS:
Medicaid-insured HS participants (N=389) were compared with Michigan beneficiaries (N=80,547). Linked Medicaid claims and vital record data were used to identify health conditions and high-risk pregnancy; AHRQ’s Clinical Classification Software diagnoses were used to identify behavioral health conditions and assess multiple health conditions during pre-pregnancy and pregnancy periods. IRB determined the study did not involve human subjects.

RESULTS:
HS participants were significantly more likely to have high-risk pregnancy claims (67.4% vs 30.2%), mental health conditions (31.9% vs. 20.2%), multiple health conditions (61% vs. 49%), prior preterm birth (6.7% vs. 3.7%), less than 12 grade education/health literacy (41.6% vs. 16.9%) and be African American (54% vs. 29%). There was a trend for chronic hypertension (5.7% vs. 4%), but no group differences for chronic diabetes (5.7% vs. 5.8%).

CONCLUSION:
Findings support that HS, equipped to address cultural and social determinants, serves many Medicaid-insured women with multiple, complex health problems, high-risk pregnancies, and mental health issues. Standard processes for program referral and coordination within practices who provide prenatal care could optimize services for high-risk women.
If You Didn’t Document It, It Didn’t Happen: Improving Documentation of Annual Visits at Resident Clinic [14F]
Authors: Mishra Supriya 
Published: April 2020

INTRODUCTION:
Improve documentation of annual exams based on ACOG’s Women’s Preventative Service Initiative. By increasing consistency in documentation, improve provided patient care.

METHODS:
Study broken into cycles: (1) A needs assessment (2) first intervention (3) post intervention analysis, (4) 2nd intervention, (5) 2nd post intervention analysis. Epic EMR between 10/2018-05/2019 used to review note documentation by examining presence/absence of the following key elements: gynecologic history section, age appropriate screening offered, HPV vaccination status, Flu vaccination status, menstrual flow, inter-menstrual bleed, healthy living tips, sexual partners, sexual dysfunction, STD testing, fertility desire, family history specific to gynecologic cancer, BMI, Smoker status, history of domestic violence, history of mental health issues. Descriptive analysis was performed using Pivot Table function in Microsoft. Chi square and Fisher exact tests were performed to look for statistical significance.

RESULTS:
One hundred and seven (n=107) notes were evaluated in needs assessment study, documentation scores varied between 1 to 15 out of 18 total. A new note template was introduced to EMR. 68 charts were analyzed and scores varied from 3-18 out of total score of 18. 2nd intervention was implemented with one-on-one feedback to providers. 21 charts were reviewed, scores varied 8-18, out of 18. Overall Median scores improved from 8 to 15 to 18 after each intervention. 15 components were noted to have a statistically significant improvement in documentation.

CONCLUSION:
Study findings support planned use of the Institute of Healthcare Improvement’s model of Plan-Do-Study-Act (PDSA) cycles to modify the EMR note template. These efforts enhance physician documentation of patient well-being.
Mifepristone Combination Therapy Versus Misoprostol Monotherapy for Early Pregnancy Loss: A Cost Analysis [17F]
Authors: Berkley Holly , Wittenberger Michael 
Published: April 2020

INTRODUCTION:
For years, mifepristone combined with misoprostol was considered standard treatment for first-trimester abortions. In 2018, ACOG finally updated its recommendations to include mifepristone for management of early pregnancy loss (EPL). Adoption of this has met resistance. One perceived barrier to the provision of mifepristone is cost. Our aim is to determine if mifepristone pretreatment adversely affects cost of medical management of EPL.

METHODS:
Decision tree analyses were constructed comparing costs of combination therapy versus monotherapy in multiple scenarios weighing provider practice, patient income, and surgical evacuation modalities for failed medical management. Rates of completed medical evacuation for each were obtained from recent randomized controlled trials.

RESULTS:
In nearly every scenario, combination therapy was favored over monotherapy. When surgical costs were higher, combined therapy was highly favored ($254.90 vs $391.60 per patient, 54% greater for monotherapy). Only when office manual vacuum aspiration was exclusively used and the patient population received minimum Federal wages was monotherapy minimally favored ($149.91 vs $152.54 per patient, 2% less for monotherapy). For equality of cost to occur in the various scenarios, the difference in completion rates between combination therapy and monotherapy needed to be between 5.6% and 15.2% - levels significantly less than that found in the literature (14.7% to 30.9%).

CONCLUSION:
Mifepristone combined with misoprostol is overall more cost effective than monotherapy and therefore cost should not be a deterrent to its adoption.
Patient Perception Regarding Education and Emotional Support Related to Early Pregnancy Complications and Loss [19F]
Authors: Metwally Hadeer , Roussos-Ross Kay , Bright Melissa 
Published: April 2020

INTRODUCTION:
Although about 15% of pregnancies end in early loss, to the individual woman, this loss is significant. Physicians are trained to identify abnormal pregnancies but are not formally trained in providing emotional care for patients following this diagnosis. The purpose of this study was to determine whether patients feel they received adequate support after an early miscarriage.

METHODS:
An anonymous survey utilizing Likert scale type questions was offered to all patients in the pregnancy loss clinic at UF Health between October 2018 and September 2019. After IRB approval, all patients had a pregnancy loss or threatened loss within the first trimester. Survey items measured perceptions of care and support following this diagnosis.

RESULTS:
A sample of 100 women participated. Nearly all women (90% and higher) reported agreeing to the following statements: I feel I spent enough time with my doctor; I feel my doctor answered all my questions; I feel my doctor did a good job explaining my diagnosis to me; My doctor gave me emotional support today. Forty-two (42%) of women reported feeling that it would be good for them to talk with someone about their feelings (counselor, therapist). Additionally, 54% reported that they would want to see a counselor within the clinic.

CONCLUSION:
Our findings suggest that women had positive perceptions of their care within this institution. However, it appears that they felt they would benefit from psychosocial support. In particular, it may be most beneficial to co-locate therapy services with clinics focused on pregnancy loss.
A Multidisciplinary Resident-Led Training on Medication-Assisted Treatment for Opioid Use Disorder [24F]
Authors: Trinh Elyse , Liu Chi-Mei , Murphy Sara 
Published: April 2020

INTRODUCTION:
This was a performance improvement project led by a first-year OB/Gyn resident with two goals: to improve resident knowledge on opioid use disorder (OUD) and medication-assisted treatment (MAT), and to increase the number of buprenorphine and methadone prescribers in Santa Clara County.

METHODS:
A four-hour, American Academy of Addiction Psychiatry-approved training was held in March 2019, attended by 25 residents from 6 institutions and 6 specialties: IM, OB/Gyn, Anesthesia, EM, Neurology, and FM. After, attendees completed an online session to become MAT prescribers. Attendees completed a pre- and post- survey assessing knowledge of MAT and OUD, and attitudes toward substance use disorders.

RESULTS:
Attendees demonstrated improvement in knowledge of OUD and MAT. 16 of the 25 attendees went on to complete the online training and earn waivers to prescribe MAT. This represents a 7.6% increase in the number of eligible prescribers in Santa Clara County.

CONCLUSION:
The opioid epidemic is a public health crisis; patients in MAT have lower mortality rates than those who are not. However, there are inadequate MAT providers. This training effectively increases resident knowledge of OUD and MAT and increases the number of MAT prescribers. It also demonstrates motivation among residents of multiple specialties to be part of the solution. The strong and diverse attendance demonstrates that resident education must be a site of intervention to curb the opioid epidemic. More must be done to create opportunities for residents to put this learning into practice.
Associations Between Chinese Immigrant Women’s Social Network Use and Cancer Screening Behavior [25F]
Authors: Guo Xiaoyue M. , Tom Laura S. , Leung Ivy S. , Simon Melissa 
Published: April 2020

INTRODUCTION:
Increasing use of social media has changed how patients obtain healthcare information, with over 90% of residents in China interacting with healthcare information online. These social media preferences likely persist in the Chinese-American population, who have amongst the lowest cancer screening prevalence among ethnic minorities in the United States. We hypothesize that health-seeking behaviors and use of social media will predict up-to-date breast and cervical cancer screening in a cohort of Chinese immigrant women. Findings may guide future outreach efforts.

METHODS:
Survey data was collected for 732 Chinese women living in Chicago’s Chinatown area from 2013 to 2018 who participated in a patient navigation program. Questions included sociodemographic information, self-reported healthcare utilization and health information-seeking behaviors.

RESULTS:
Most respondents (60%) were aged 50 or older, had less than a college education (92%), and an annual income <$20,000 (55%). Nearly all (94%) spoke Chinese, and over 80% had public or no insurance. 44% have sought out health information, with the majority using the Internet. Of participants who responded to social network questions, 71% reported using social media, 55% of whom reported looking to contacts for health opinions and information. Seeking health information was associated with receiving appropriate Papanicolaou (within 5 years) and mammogram screening (within 2 years; all P<.05), whereas using social media trended towards receiving appropriate mammogram screening (P=.08).

CONCLUSION:
As healthcare-seeking behavior and use of social media are associated with improved cervical and breast cancer screening, leveraging use of social media networks may help increase cancer screening behaviors in the Chinese-American population.
Differences in Knowledge of Colorectal Cancer Screening and Its Contribution to Screening Practices by Ob/Gyns [27F]
Authors: Clare Camille , Liu Clive 
Published: April 2020

INTRODUCTION:
Colorectal cancer is the second most commonly diagnosed cancer in women. Surveys show that physicians have an influence in the rates of colorectal screening. This study investigates whether a lack of colorectal screening knowledge prevents Ob/Gyns of different academic levels and practice types from effectively screening colorectal cancer.

METHODS:
An IRB approved, validated survey eliciting colorectal screening guidelines, practices, and potential barriers to screening was circulated online, at the National Medical Association national conference, ACOG District II conference, and the New York City Health + Hospitals/Metropolitan Dept of Ob/Gyn between October 2018 to January 2019.

RESULTS:
A total of 142 respondents answered the survey. Only one out of 142 respondents (0.7%) answered correctly the question which identified all of the risk factors for colorectal cancer. A significant difference was noted in correctly identifying risk factors when comparing attendings (36.6%) and residents (75%) P=.004. Most respondents were able to correctly identify age to start screening (93.6%), but fewer were able to correctly identify age to stop screening (23.2%). For screening intervals, 76.8% correctly answered for colonoscopy, 66.9% correctly answered for flexible sigmoidoscopy. A significant difference was noted after stratifying for age (ages 20-40 vs 50-70s P=.003), gender (women vs men P=.01), and academic level (resident vs attending P=.03): younger, resident, and female physicians provided more correct answers.

CONCLUSION:
Difference in colorectal cancer screening knowledge between residents and attendings contributes to less than effective screening. Education on colorectal cancer should focus on attendings through maintenance of certification and continued integration in residency education.
Period Poverty and the Menstrual Product Tax in the United States [29F]
Authors: Singh Bhuchitra , Zhang Jiahui , Segars James 
Published: April 2020

INTRODUCTION:
Period poverty refers to the lack of access to menstrual products. The “luxury tax” collected on menstrual products in the majority of the United States is a major contributor to period poverty and a barrier to reproductive health for the estimated 16.9 million women living in poverty in the U.S. In this study, we sought to determine the financial, social, and political impact of the menstrual product tax on women of reproductive age in the U.S.

METHODS:
The cost and sales tax collected on a sample menstrual product (Playtex Sport Tampons, Regular & Super Multi Pack, Unscented – 50 Count) was compared when purchased through online retailers Amazon, Walmart, and Target in each state of the U.S. and the District of Columbia.

RESULTS:
As of June 2019, thirty-five states taxed menstrual products at rates between 4.70%; in Hawaii to 9.90%; in Louisiana, with a mean of 7.41%. Among them, nineteen states taxed between 6 and 7.99%, twelve at >8%, and only four states at <6%. This financial burden decreased the accessibility of menstrual products specifically for the marginalized low-income women and women with heavy menstrual bleeding. The lack of access to menstrual products led to poor menstrual hygiene, decreased participation in work and other activities and contributed to poor quality of life.

CONCLUSION:
The menstrual product tax exacerbates period poverty and negatively impacts the quality of life of women by decreasing the accessibility of menstrual products. Our research supports the repeal of this tax in consideration of its financial, social, and political implications.
Association Between Endometriosis and Lower Urinary Tract Symptoms [34F]
Authors: Gabriel Iwona , Vitonis Allison , Missmer Stacey , Terry Kathryn , DiVasta Amy , Minassian Vatche 
Published: April 2020

INTRODUCTION:
Lower urinary tract symptoms (LUTS) as frequency, urgency, nocturia, and dysuria significantly affect women of all ages. We hypothesize LUTS are more commonly experienced by women with endometriosis than without.

METHODS:
We conducted a cross-sectional study of 1161 women who participated in The Women’s Health Study: from Adolescence to Adulthood. At baseline, participants completed questionnaire that included questions on the following LUTS in the past three months: loss of urine when coughing, sneezing or laughing; difficulty passing urine; blood in the urine; still feeling full after urination; and having to urinate again within minutes of urinating, dysuria (pain >5 in 1-10 scale). Women who did not complete LUTS questions or who reported frequent bladder infections were excluded. We used logistic regression modelling adjusted for race, current age, BMI, parity to estimate odds ratios (OR) and 95% confidence intervals (CI) of the associations between endometriosis and LUTS. The study was approved by IRB.

RESULTS:
Participants were predominantly white non-Hispanic (89% of cases, 72% -controls) and nulliparous (95% of cases, 91% -controls), with age range 7-55. Participants with endometriosis more frequently reported still feeling full after urination (77% vs. 23%, OR 5.14, CI 3.23-8.18), having to urinate again within minutes (61% vs. 39%, OR 2.45, CI 1.81-3.32), difficulty passing urine (76% vs. 24%, OR 3.41, CI 1.71-6.81), and dysuria (66% vs. 35%, OR 2.58, CI 1.57-4.26). LUTS were not associated with duration of endometriosis symptoms nor rASRM stage.

CONCLUSION:
Women with endometriosis report LUTS significantly more often than those without. Addressing LUTS may improve the wellbeing of women with endometriosis.
Patient Characteristics and Treatments for Women With Moderately Severe Fecal Incontinence [36F]
Authors: Rivera Gabrielle , Stewart Kelley , Jeppson Peter , Petersen Timothy , Dunivan Gena 
Published: April 2020

INTRODUCTION:
Surgical treatments, such as sphincteroplasty or sacral neuromodulation, are available for fecal incontinence (FI). There has been increasing attention on the progress to surgical treatment for overactive bladder, but little is known about the progress towards this therapy for FI.

METHODS:
This was a retrospective chart review of all new patients presenting to an academic Urogynecology clinic with Wexner Incontinence Scale scores of 11-14 (equivalent to moderately severe FI). Demographics, prior treatments, and how long it took for patients to proceed to definitive treatment were collected. Our prior work described women with severe FI (Wexner score 15–20). With this study we sought to describe women with moderately severe FI and compare moderate to severe FI groups.

RESULTS:
From January 2014 to July 2017, 158 new patients with a Wexner score of 11-14 were seen in clinic. The mean age was 62.5 +/-12 years. The majority (n=117, 77%) had never had any treatment for FI. The most common treatment plan at the first visit was fiber and dietary modifications (n=59, 38%). Only 3 patients went on to surgical treatment. There were no significant differences between those with moderate versus severe FI in how many ultimate progressed to surgical therapy (3 versus 6) or the number of clinic visits until that decision was made (2 versus 3), all p>.05.

CONCLUSION:
Very few patients progress to surgical treatment despite at least moderately severe FI. Further work is needed to facilitate timely delivery of definitive care for this patient population.