bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identifying the “Who” of the Sex-Trafficked Population of Phoenix [02F]
Authors: Segaline Nicole , Lee Maurice , Roe-Sepowitz Dominique 
Published: April 2020

INTRODUCTION:
Sex-trafficking is one of the world’s fastest growing forms of crime worldwide, and yet less than 2% of victims have been identified. In 2016, there was an estimated 30% increase in reported cases of human trafficking in Arizona. The number of risks and harms endured by sex-trafficked individuals is lengthy, yet strategies and education to identify victims is not universal. The purpose of this study is to further understand the demographics and medical needs of the sex trafficked population of Phoenix.

METHODS:
Project STARFISH is a biannual drop-in center that provides resources to victims of sex- trafficking. Medical SOAP notes are written on persons who voluntarily seek medical services at these resource centers. Eighty de-identified SOAP notes were reviewed in this IRB-approved observational, qualitative study to determine demographic and medical needs of the sex-trafficked population of Phoenix.

RESULTS:
The analysis revealed a high incidence of pregnancy, polysubstance use, homelessness, sexually transmitted infections, domestic violence history, chronic pain and mental health needs. Additionally, demographics of this population were extrapolated and include a predominately female population, an average age of 35 years old, with 78% of people having health insurance, and one-third having regular contact with a primary physician.

CONCLUSION:
The evidence regarding the sex-trafficked population is limited, and this project helps gain valuable insight regarding the demographics and medical needs of this under-researched population. The impact of this project is threefold: identification of victims, education for healthcare professionals, and creation of open communication channels between victims and healthcare providers.
Implementation of Surgical Debriefing in Gynecologic Surgery [04F]
Authors: McHenry Victoria M. , Straney Jennifer 
Published: April 2020

INTRODUCTION:
The surgical debrief is a standardized checklist performed near the conclusion of a surgery, similar to the pre-procedure “Time Out.” This surgeon lead debrief confirms correct procedures and specimens, addresses anesthesia concerns, patient disposition, and allows all team members to participate in discussions regarding case efficiency. It has been studied in several surgical fields and shown to improve operating room safety and communication, increase efficiency, and decrease morbidity. It also provides opportunities for educational feedback in academic institutions. The surgical debrief has not been studied in gynecologic surgery. This study evaluates the implementation of a standardized surgical debrief at a teaching hospital.

METHODS:
This is a quality improvement study using PDSA (plan-do-study-act) cycles to implement surgical debriefs in all gynecologic surgeries performed at this hospital. All OR team members took pre/post implementation surveys regarding OR safety and communication and received surgeon lead education regarding implementation protocols. IRB approval was obtained.

RESULTS:
In PDSA cycle 1, 59% (33/56) of eligible gynecologic surgeries completed debriefs. In PDSA cycle 2, debriefs were completed in 70% (40/57) of eligible gynecologic surgeries. Immediate resident feedback occurred in 46% of the cases that completed debriefs.

CONCLUSION:
The surgical debrief was successfully implemented into gynecologic surgery. Anonymous survey results by the vast majority of OR personnel felt the debrief enhanced OR safety, improved communication, and prompted immediate resident feedback in such a positive way, that it has been adopted routinely for all cases, amongst all surgical specialties at this institution.
Improvement of Operative Vaginal Delivery Training in Residency: A Single Institution Experience [17G]
Authors: Negi Masaru , Espinal Mariana , Holveck Beth , Mehlhaff Krista , Cron Julia , Pettker Christian Michael 
Published: April 2020

INTRODUCTION:
Operative vaginal delivery (OVD) rates are decreasing in the US, creating fewer opportunities for trainee participation. Residents, not adequately trained in OVD, are less likely to use this skill after training, contributing to a growing cesarean rate. We aimed to improve resident participation in OVD.

METHODS:
Retrospective analysis from July 2017 to December 2018 of an intervention bundle applied prospectively on all OVDs performed at Yale New Haven Hospital. Staff and clinicians were interviewed to assess barriers to resident participation. Interventions applied: 1) training of residents in didactics and simulations on OVD, 2) outreach to providers to create awareness and comfort with resident participation, and 3) change of workflow on the Labor & Birth unit to improve notification to the resident team about OVD events through a mobile texting tool. Our goal was to achieve >90%; resident participation in OVD, calculated to meet the ACGME minimum. Process control and run charts were used for analysis.

RESULTS:
There were 214 OVDs. Overall mean resident coverage was 83.6%. Prior to intervention, the median attendance rate of residents at OVD was 76%. After intervention, the median monthly coverage rate was 100%. Prior to intervention, process control chart analysis shows multiple points outside control limits (outside 3 standard deviations). After intervention, there were no points outside of control limits, and >8 points were above the median consecutively, showing achievement of process control. Mean attendance rate after intervention was 98.7%.

CONCLUSION:
Resident participation in OVD increased to the target rate with implementation of low cost, low technology solutions.
Introduction of Wireless Buzzer to Improve Efficiency in Gynecology Triage: A Quality Improvement Initiative [18G]
Authors: Stansbury Nicholas , Nelson Erin , Chavez Clarisa , Taylor Marlow 
Published: April 2020

INTRODUCTION:
Current workflow in GYN triage has medical students interviewing patients after triage by nursing staff. The optimal time to initiate patient contact is unclear. This confusion has led to duplication of questions to patients, interruptions for nurses and fewer patient encounters for students.

METHODS:
A Plan-Do-Study-Act approach was used. Stakeholders were medical students, nurses, Nurse Practitioners and physicians. Factors contributing to workflow slowdown: students re-asking questions of patients, interruption of nursing staff, confusion about optimal patient flow. The net result was fewer interviews completed by students. The project was introduced during clerkship orientation. Buzzers were provided on weeks 1, 3, 5 of the rotation. Weeks 2, 4, 6 no buzzers were provided as an internal control. After each clerkship, students received a survey assessing key areas of waste and workflow disruption. A focus group with ten nurses was also conducted.

RESULTS:
From February-July 2019, 30/45 surveys were completed (66%): 1. Very difficult/difficult to know when to begin the encounter: 90% without; 21.4% with buzzer P<.001; 2. Students re-asking questions: very often/often 96.7% without; 14.8% with buzzer P<.001; 3. Nursing staff interruptions: 76.7% very often/often without; 18.5% with buzzer P<.001; 4. The odds of interviewing 5 or more patients per shift are ∼10X greater using the buzzer χ2=14.2; P<.001.

CONCLUSION:
The 10 nurses interviewed unanimously favored the use of the buzzer. Introduction of a simple, low-cost restaurant-style buzzer improved triage workflow, student and nursing experience.
Performance of a Patient Engagement App for Pre-Op Education [20G]
Authors: Cherot Elizabeth , Kett Attila , Siddiqui Zishan 
Published: April 2020

INTRODUCTION:
Enhanced recovery after surgery is an innovation in perioperative care with the goal to achieve better patient engagement and improved outcomes like reduced opiate use and decreased hospital stay. Features are designed to accelerate patient recovery by reducing surgical stress and support physiologic function by allowing po intake shortly before surgery, multi-modal pain management, and early mobilization. Keys to success are patient education, engagement and self-efficacy. The program is dependent on assessing several patient reported care milestones like discontinuation of the Foley catheter, ambulation and pain scores. Because this is a human resource intensive endeavor, we developed an app with the goal of better engagement, education and response tracking while reducing human resources.

METHODS:
We deployed an app with the following components: multimedia education, reminders and check lists with the ability for patient reported data collection. Patients activated the app 3 weeks before surgery and used the tool for data collection pre and post operatively. We wanted to demonstrate patients consumed the educational content, responses to the surveys and compliance with our program preoperatively.

RESULTS:
We had 285 patients undergo ERAS program with 97.54% activation of our app before surgery, 92.86% response rate in the first week, 75.51% in the second week. 56.16% reported the app prevented 1 or more phone calls and 12.33% reported prevention of 1 or more visits to the hospital.

CONCLUSION:
We demonstrated both feasibility, high patient engagement and utilization for our app. One should consider using to unburdened staff and means to perform patient driven data collection.
Reducing Results Delivery Time for Couples Undergoing Carrier Screening: A “Tandem-Reflex” Strategy [24G]
Authors: Arjunan Aishwarya , Kaseniit Kristjan Eerik , Wootton Jeff , Taber Katherine Johansen 
Published: April 2020

INTRODUCTION:
Obtaining carrier screening results in a timely manner is important to support reproductive decision-making. Reproductive partners are typically tested in a sequential manner: the female is tested first and if a carrier, her partner is tested. This imposes workflow challenges due to the need for a subsequent visit to draw the partner’s sample, reducing the likelihood of the partner getting screened and hampering detection of at-risk couples. We implemented a “tandem reflex” strategy wherein both partners submit samples in tandem but are tested sequentially, with the second partner’s sample tested only if the first partner was found to be a carrier.

METHODS:
The time to delivery of a combined report was measured before and after implementation of the “tandem reflex” strategy. Comparison to a simultaneous strategy, ie, both partners samples tested as soon as they are received, is also reported.

RESULTS:
Before implementing the “tandem reflex” strategy, the average time for a sequentially tested couple to receive a report was 35 days (95th percentile 76 days, N=16,785 couples). After implementation, the average time was reduced to 15 days (95th percentile 25 days, N=1,132 couples). Among 13,161 couples tested simultaneously, 42% of females were negative for all tested conditions; in this scenario, the tandem reflex strategy would have reduced unnecessary testing because it would not have triggered testing of the male partner.

CONCLUSION:
The “tandem reflex” strategy time to receipt of a combined report by half, allowing for more timely reproductive and pregnancy management.
The Silent Killer: Resident Burnout at an Inner-City Hospital in New York [25G]
Authors: Jackman Janelle , Hayfron Maame , Hwang Lewis , Riccardi MaryAnn , Valentine Menogh , Hakkim Ansi 
Published: April 2020

INTRODUCTION:
Burnout defined by Maslach Burnout Inventory (MBI) is emotional exhaustion, depersonalization, and feelings of decreased personal accomplishment. Medical residents endure higher levels of burnout compared to general population. The purpose of this study is to evaluate resident’s personality traits, stress level and alleviating techniques to promote resident wellness at a single community hospital.

METHODS:
In 2017, an anonymous survey was administered to all 143 residents at the Brooklyn Hospital. It assessed personality traits, stress level and stress alleviating techniques. It contained questions from the Rosenbach Self-Esteem scale, the Perceived Stress Scale and the MBI scale, along with demographics. Participation was voluntary and 100 residents completed the survey. Statistical analysis used Chi-square test and Students t-test linear regression. P-value<0.05 was statistically significant.

RESULTS:
OBGYN residents were more likely to report higher scores in the emotional exhaustion component of the MBI vs. residents of other specialties. There were no statistically significant differences in Personal Accomplishment and Depersonalization scores across all specialties. Burnout was significantly higher in OBGYN residents compared to surgery and pediatrics residents, as well as in family medicine vs. surgery residents. Post graduate year (PGY)-4s had significantly higher self-esteem scores (SES) than other PGY residents. Surgery residents had the highest self-esteem score.

CONCLUSION:
Burnout can have unintended consequences including psychological distress, altered personal relationships and decreased quality of patient care. Interventions to improve resident well-being should promote a sustainable environment for residents to thrive in by aggressively addressing excessive workload and incorporating individualized tactics such as routine counseling and therapy sessions.
Obstetric Innovation as Indicated by Venture Capital Funding [33G]
Authors: Kogutt Benjamin K. , Satin Andrew J. 
Published: April 2020

INTRODUCTION:
Venture capital (VC) is a financial industry that supports early stage companies and thus innovation. As such, VC funding has been theorized to serve as a proxy for level of innovation across multiple industries including healthcare. Innovation in obstetrics is critical to improving the lives of pregnant patients. Anecdotally however, innovation in the obstetric field is lagging. Therefore, our objective was to determine the level of VC funding in obstetrics compared to other seemingly innovative specialties.

METHODS:
We performed a retrospective cohort study utilizing propriety data (Pitchbook, Seattle, WA) to compare VC trends within Obstetrics and four additional specialties. Once cohorts were identified, “capital invested,” number of “VC-companies,” number of “deals,” number of “investors,” “exits” (IPOs), and “largest deal” were extracted and compared.

RESULTS:
Obstetrics had the lowest level of capital invested, the smallest number of funded companies, and the least amount of deals brokered between 2000 and 2018. Obstetrics was also identified as having the slowest rate of VC funding growth, but did have the third highest rate of growth in “companies” and “deal count.”

CONCLUSION:
Obstetrics has the lowest level of innovation as measured by VC funding, VC-funded companies, VC deals, and rate of growth of VC funding compared to other specialties. However, company and deal growth rates were the third highest, indicating that Obstetrics has not yet realized its full, innovative potential. This is both encouraging and demanding given the great need for urgent, innovative solutions for obstetrics’ most pressing dilemmas including the rising US maternal mortality rate.
Pregnant Women Value Advice From Providers Over That From Friends/Family Regarding Sleep, Nausea and Substance Use [36G]
Authors: Satti Mohamed A. , Power Michael L. , Reed Eda G. , Wenker Elizabeth S. , Schulkin Jay , Mackeen A. Dhanya 
Published: April 2020

INTRODUCTION:
We aimed to evaluate pregnant women’s opinions of advice from healthcare providers versus from friends and/or family members, regarding nausea, sleep, and substance (alcohol, marijuana, tobacco and caffeine) use during pregnancy.

METHODS:
The is a cross-sectional study. All pregnant women who received prenatal care at Geisinger were provided surveys. Women with limited English-speaking proficiency were excluded.

RESULTS:
Of the 284 women, 87% were white, 49% married, and 61% had private health insurance. About half (47%) had prenatal care with a physician, 14% with a certified nurse midwife, and 34% with a nurse practitioner or physician assistant. Overall, women were more interested in advice about nausea, sleep and caffeine use, rather than alcohol, tobacco and marijuana use. Regarding improving sleep and decreasing nausea, 90% felt it was important to receive advice from providers and 73% felt it was important to receive advice from friends/family. With regards to substance use, 74% of women felt advice from health care providers was important compared to only 43% of women who thought advice from friends/family was important. About 20% of the women did not value advice from either source regarding alcohol, marijuana, and tobacco. For all these concerns, twice as many women felt that provider advice was more important than advice from friends/family.

CONCLUSION:
Pregnant women in this study more highly valued advice about reducing nausea, improving sleep and caffeine consumption more so than advice about tobacco, marijuana and alcohol use during pregnancy. Most believed that advice from their healthcare provider was more valuable than advice from friends/family.
The Effect of Distraction on the Quality of Patient Hand-Off [39G]
Authors: Persad Vashisht , McLaren Rodney Anthony , Joslin-Roher Sophia , Narayanamoorthy Sujatha , Silver Michael , Minkoff Howard 
Published: April 2020

INTRODUCTION:
To evaluate whether distraction affects the quality of sign-out among obstetrical providers. If distractions affect the accuracy of information shared at “sign-out,” it could lead to errors in patient management.

METHODS:
A randomized, prospective study among obstetrical providers who received a recorded sign-out vignette. Provider groups either received a distraction or did not during the vignette. All providers had been told that they would be participating in a trial of two methods of sign out, although in actuality they were all signed out using a single method. In the distraction arm, the participants were exposed to a “distracting event” (a phone ring, followed by a short response) that occurred midway through the vignette. Providers answered a 14-question survey based on the vignette. The results of each group were analyzed using Fisher exact and Student t tests.

RESULTS:
Eighty-eight providers were randomized, 44 in the distraction group and 44 in the non-distracted group. The score averages on the survey were similar between groups (11.0 and 10.8, P=.57). In addition, the average scores for questions that occurred after the distraction were similar between the distracted and non-distracted groups (6.4 vs 6.2, P=.42). Proximity to the distraction did not affect scores.

CONCLUSION:
While cell phones often ring in hospital settings, we did not find that a single phone ring and a brief answer to the call affected obstetrical providers’ recall of details of a standardized sign-out. More studies are warranted to determine if more frequent distractions or longer distractions would change results.
Access to Minimally Invasive Gynecologic Surgery for Adnexal Surgery: Impact of Race and Payer Mix [03H]
Authors: Palvia Vijay , Finkelstein Mark , Zakashansky Konstantin , Brodman Michael , Ascher-Walsh Charles , Khalil Susan 
Published: April 2020

INTRODUCTION:
Minimally invasive gynecologic surgery is associated with many benefits. Adoption for hysterectomy, has noticeable variation with race. The Statewide Planning and Research Cooperative System (SPARCS) is a comprehensive all payer data reporting system, the result of cooperation between healthcare industry and government including outpatient and inpatient information on procedures, diagnosis, and patient factors.

METHODS:
The (SPARCS) database was reviewed from 2011–2015, for ovarian-cystectomy with/without salpingectomy for benign indications, performed via laparotomy and laparoscopy.

RESULTS:
There were 68,029 patients included in this analysis. Average age was 43 years, with 81.3% between 18–55, 17.7% >55. Racial composition comprised of 68.7% Caucasian, 4.8% Asian, 11.2% Black, and 15.3% as other. Payor mix included 79.6% insured, 7.4% Medicaid, 8.3% Medicare, and 4.7% other or self-payment. Majority resided in metropolitan areas (90.6%), and did not travel >15 miles for care. Of the 68, 029 that were included, 54,829 were performed via laparoscopy while 13,200 were via laparotomy. Odds ratio (OR) of having procedure via laparoscopy was 0.68 for black, 0.81 for Hispanic, and 0.80 for other. Compared to insured: OR that surgery was via laparoscopy was 0.69 for Medicaid, 0.72 for Medicare, 0.92 self. At high-volume surgical facilities the OR laparoscopy was utilized was 1.83 compared to a low volume facility, and 1.49 at medium volume facilities. At institutions with major teaching affiliation the OR was 0.91 compared to non-teaching, and the OR was 1 for minor affiliation.

CONCLUSION:
Race is not the only factor associated with lower likelihood of laparoscopy, other factors such as institution type also impact likelihood.
Development of a Postoperative Opioid Prescription Practice (POPP) Algorithm for Benign Gynecologic Surgery [05H]
Authors: Thompson William , Fielden Aaron , Elmezzi Kristen , Yamasaki Meghan , Endicott Scott , Braden Jacqueline 
Published: April 2020

INTRODUCTION:
Pain Management literature shows a strong correlation between days of initial opioid use and risk for chronic use. Opioid-prescribing practices vary widely within OB/GYN literature. The purpose of this study is to determine if gynecologic patients have satisfactory postoperative pain control using a novel Postoperative Opioid Prescription Practice (POPP) algorithm.

METHODS:
Patients undergoing benign gynecologic surgery at a large military treatment facility were recruited for this IRB-approved study. Patients completed a preoperative survey regarding baseline pain, substance use, chronic pain, depression or anxiety, and home pain management strategies. The quantity of opioids dispensed postoperatively was determined using the POPP algorithm. Patients completed a two-week postoperative survey assessing the number of remaining opioid tablets and their pain satisfaction. The current study group was compared to a retrospective cohort of patients treated for similar conditions.

RESULTS:
Final analysis included 68 patients from the 82 patients initially recruited. 97% of patients did not require an opioid refill and were satisfied with their postoperative pain control. 21% did not require any opioids following discharge. The POPP algorithm reduced opioid prescriptions from an average of 22.5 to 12.5 tablets.

CONCLUSION:
Use of the POPP algorithm resulted in a significantly decreased number of opioid tablets prescribed. The majority of patients were satisfied with their postoperative pain control and did not require refills of opioids despite less tablets prescribed. The POPP algorithm is a good starting point to guide gynecologic surgeons in postoperative opioid-prescribing practices. More data is needed to develop even stricter opioid prescription algorithms based on patient characteristics.