bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Students’ Views on Implementing the Core EPAs: Recommendations From Student Leaders at the Core EPAs Pilot Institutions
Authors: Geraghty Joseph R. , Ocampo Raechelle G. , Liang Sherry , Ona Ayala Kimberly E. , Hiltz Kathleen , McKissack Haley , Hyderi Abbas , Ryan Michael S. 
Published: October 2020

In 2014, the Association of American Medical Colleges recruited 10 institutions across the United States to pilot the 13 Core Entrustable Professional Activities for Entering Residency (Core EPAs). The goal was to establish a competency-based framework to prepare graduating medical students for the transition to residency. Within the Core EPAs pilot, medical students play an influential role in the development and implementation of EPA-related curricula. Student engagement was a priority for the Core EPAs institutions given students’ roles as the end users of the curriculum, thus they may offer valuable insight into its design and implementation.
Here, the authors provide the perspective of medical students who serve as leaders in the Core EPAs pilot at their respective institutions. They describe student leadership models across the pilot institutions as well as 6 key challenges to implementation of the Core EPAs: (1) How and when should the Core EPAs be introduced? (2) Who is responsible for driving the assessment process? (3) What feedback mechanisms are required? (4) What systems are required for advising, mentoring, or coaching students? (5) Should EPA performance contribute to students’ grades? and (6) Should entrustment decisions be tied to graduation requirements?
Using a polarity management framework to address each challenge, the authors describe inherent tensions, approaches used by the Core EPAs pilot institutions, and student-centered recommendations for resolving each tension. By sharing the experiences and perspectives of students engaged in the Core EPAs pilot, the authors hope to inform implementation of EPA-oriented assessment practices and feedback across institutions in the United States.
Establishing Validity for a Vaginal Hysterectomy Simulation Model for Surgical Skills Assessment
Authors: Chen Chi Chung Grace , Lockrow Ernest G. , DeStephano Christopher C. , Nihira Mikio A. , Matthews Catherine , Kammire Leslie , Landrum Lisa M. , Anderson Bruce D. , Miyazaki Douglas 
Published: October 2020

OBJECTIVE:
To use the Messick validity framework for a simulation-based assessment of vaginal hysterectomy skills.

METHODS:
Video recordings of physicians at different levels of training and experience performing vaginal hysterectomy on a high-fidelity vaginal surgery model were objectively assessed using a modified 10-item Vaginal Surgical Skills Index, a one-item global scale of overall performance, and a pass–fail criterion. Participants included obstetrics and gynecology trainees and faculty from five institutions. Video recordings were independently assessed by expert surgeons blinded to the identities of the study participants.

RESULTS:
Fifty surgeons (11 faculty, 39 trainees) were assessed. Experience level correlated strongly with both the modified Vaginal Surgical Skills Index and global scale score, with more experienced participants receiving higher scores (Pearson r=0.81, P<.001; Pearson r=0.74, P<.001). Likewise, surgical experience was also moderately correlated with the modified Vaginal Surgical Skills Index and global scale score (Pearson r=0.55, P<.001; Pearson r=0.58, P<.001). The internal consistency of the modified Vaginal Surgical Skills Index was excellent (Cronbach's alpha=0.97). Interrater reliability of the modified Vaginal Surgical Skills Index and global scale score, as measured by the intraclass correlation coefficient, was moderate to good (0.49–0.95; 0.50–0.87). Using the receiver operating characteristic curve and the pass–fail criterion, a modified Vaginal Surgical Skills Index cutoff score of 27 was found to most accurately (area under the curve 0.951, 95% CI 0.917–0.983) differentiate competent from noncompetent surgeons.

CONCLUSION:
We demonstrated validity evidence for using a high-fidelity vaginal surgery model with the modified Vaginal Surgical Skills Index or global scale score to assess vaginal hysterectomy skills.
Risk Factors for Surgical Failure and Worsening Pelvic Floor Symptoms Within 5 Years After Vaginal Prolapse Repair
Authors: Jakus-Waldman Sharon , Brubaker Linda , Jelovsek John Eric , Schaffer Joseph I. , Ellington David R. , Mazloomdoost Donna , Whitworth Ryan , Gantz Marie G. ,   for the NICHD Pelvic Floor Disorders Network (PFDN)
Published: October 2020

OBJECTIVE:
To assess independent risk factors for surgical failure and worsening pelvic floor symptoms within 5 years after vaginal prolapse surgery.

METHODS:
This secondary analysis includes OPTIMAL (Operations and Pelvic Muscle Training in the Management of Apical Support Loss) (n=374) and E-OPTIMAL (Extended) (n=285) trial participants. Surgical failure was defined as apical descent greater than one third of the total vaginal length, anterior or posterior vaginal wall past the hymen, subsequent surgery or bothersome vaginal bulge. Worsening pelvic floor symptoms were defined as increases from baseline as large as the minimally important difference for subscale scores of the Pelvic Floor Distress Inventory: 11 for the Urinary Distress Inventory and Colorectal-Anal Distress Inventory and 34.3 for the Pelvic Organ Prolapse Distress Inventory. Outcomes were measured at 6 months then 1, 2, 3, 4, and 5 years. Chi-square and t test results from bivariate models and clinical relevance were used to inform final models.

RESULTS:
Baseline risk factors for surgical failure were Hispanic ethnicity (adjusted odds ratio [aOR] 1.92, 95% CI 1.17–3.15), perineal body (aOR 1.34, 95% CI 1.09–1.63), and pretreatment Pelvic Organ Prolapse Distress Inventory score (aOR 1.16, 95% CI 1.05–1.28). Risk factors for worsening of pelvic floor symptoms were pretreatment Pelvic Organ Prolapse Distress Inventory score (aOR 0.75, 95% CI 0.60–0.94) for worsening Pelvic Organ Prolapse Distress Inventory score, vaginal deliveries (aOR 1.26, 95% CI 1.10–1.44) and pretreatment Urinary Distress Inventory score (aOR 0.86, 95% CI 0.80–0.93) for worsening Urinary Distress Inventory score, and age (aOR 1.03, 95% CI 1.01–1.05) and pretreatment Colorectal-Anal Distress Inventory score (aOR 0.95, 95% CI 0.92–0.98) for worsening Colorectal-Anal Distress Inventory score.

CONCLUSIONS:
Hispanic ethnicity, larger preoperative perineal body, and higher pretreatment Pelvic Organ Prolapse Distress Inventory scores were risk factors for surgical failure up to 5 years after vaginal prolapse repair. Participants with higher baseline Pelvic Floor Distress Inventory scores were less likely to worsen. Risk factors for worsening Urinary Distress Inventory and Colorectal-Anal Distress Inventory scores included more vaginal deliveries and increased age, respectively.

CLINICAL TRIAL REGISTRATION:
NCT00597935, NCT01166373.
Evaluation of an Inpatient Postpartum Human Papillomavirus Immunization Program
Authors: Avni-Singer Lital , Oliveira Carlos R. , Torres Ashlynn , Shapiro Eugene D. , Niccolai Linda M. , Sheth Sangini S. 
Published: October 2020

OBJECTIVE:
To evaluate the result of an inpatient postpartum human papillomavirus (HPV) immunization pilot program in a diverse, low-income patient population from an urban, hospital-based obstetrics and gynecology clinic.

METHODS:
In this cohort study, we present results from the first 2 years of the inpatient postpartum HPV immunization program, in which vaccine-eligible postpartum women were identified and immunized during their hospital stays. The program was implemented after educational outreach with prenatal and postpartum clinicians and nurses. Associations between receipt of the HPV vaccine as an inpatient and the characteristics of patients, and the likelihood of and missed opportunities for receiving a subsequent dose of the HPV vaccine as an outpatient were determined using logistic regression, time-to-event analyses, chi-squared tests and t-tests.

RESULTS:
From April 11, 2017, to April 10, 2019, 394 (59.2%) of 666 postpartum women were eligible for the inpatient postpartum HPV immunization program. The majority (265/394, 67.3%) received the immunization pilot program HPV dose; 36 of those 265 (13.6%) completed the series with that dose. Among women due for additional doses after hospital discharge, those who received the inpatient dose were more likely to receive a subsequent outpatient dose (138/229) than were those who did not receive an inpatient dose (39/129; hazard ratio 2.51, 95% CI 1.76–3.58). On average, there were 30.7 fewer (95% CI 5.8–55.6, P<.02) missed opportunities for subsequent outpatient doses for every 100 eligible visits among women who received the inpatient dose, compared with women who did not. By the end of the study, the proportion of women who had completed the vaccine series was higher among women who received the inpatient dose (95/265, 35.8%) than in those who did not (12 out 129, 9.3%; odds ratio 5.45, 95% CI 2.86–10.38).

CONCLUSION:
The inpatient postpartum HPV immunization program was associated with increased rates of immunization and addressed a previously missed opportunity. Inpatient immunization programs can serve as a critical way to address gaps in vaccine uptake.
Association of a Pediatric Gynecology eLearning Module With Resident Knowledge and Clinical Skills
Authors: Huguelet Patricia S. , Abraham Margaret , Alaniz Veronica I. , Dolinko Andrey V. , Dumont Tania , Karjane Nicole , Pearce Janina V. , Ruder Kara , Wheeler Carol , Guiahi Maryam 
Published: October 2020

OBJECTIVE:
To assess whether a pediatric and adolescent gynecology electronic learning (eLearning) module improves knowledge and clinical performance among obstetrics and gynecology residents.

METHODS:
We conducted a multi-institutional, single-blinded, randomized controlled trial across four university programs; three had pediatric and adolescent gynecology rotations, and two had pediatric and adolescent gynecology fellowship-trained faculty. Applying permutated block randomization, residents were randomized to no intervention or completion of a validated eLearning module on prepubertal bleeding. All residents subsequently completed a pediatric and adolescent gynecology–related knowledge assessment that queried understanding of prepubertal bleeding and an objective structured clinical examination that assessed history collection, performance of a prepubertal genital examination, vaginal culture, and vaginoscopy for a pediatric patient. Objective structured clinical examinations were videotaped and reviewed by two faculty, blinded to randomization group; interrater reliability score was 97%. We calculated descriptive frequencies and compared randomization groups using χ2 analyses and Fisher exact tests for categorical variables, and median tests for continuous variables; a value of P<.05 was considered significant.

RESULTS:
From July 2018 to June 2019, we invited 115 residents to participate; 97 (83%) completed both objective structured clinical examination and follow-up knowledge assessments. Most were female (91%) and the majority reported limited pediatric and adolescent gynecology didactic or clinical experience, with 36% reporting prior didactics on prepubertal vaginal bleeding and 33% reporting prior exposure to the prepubertal genital examination. Forty-five participants (46%) were randomized to the module and groups were similar across training levels. Residents assigned to the module scored significantly higher on the knowledge assessment (4/5 vs 2/5, P<.001) and objective structured clinical examination (13/16 vs 7/16, P<.001) and were more likely to avoid a speculum in the examination of a pediatric patient (95.6% vs 57.7%, P<.001).

CONCLUSION:
Our pediatric and adolescent gynecology eLearning module resulted in improved short-term resident knowledge and simulated clinical skills among obstetrics and gynecology residents. Applying this learning technique in other programs may help address deficiencies in pediatric and adolescent gynecology education and training.
Wireless Laparoscopy in the 2020s
Authors: Chatzipapas Ioannis , Kathopoulis Nikolaos , Siemou Panagiota , Protopapas Athanasios 
Published: October 2020

BACKGROUND:
Wireless signal transduction is the future in the field of laparoscopic surgery. Cable-free endoscopic equipment would be the ideal surgical instrument for every laparoscopic surgeon.

INSTRUMENT:
Our department has developed a new cable-free laparoscopic setup that couples a rigid 0°, 10-mm laparoscope with a wireless camera modified with a special adapter. We used a portable and rechargeable LED cold light source. The signal was wirelessly transmitted from the camera to a tablet computer using the corresponding mobile application.

EXPERIENCE:
Our team has used this setup in 14 laparoscopic operations with excellent results. Two cases performed exclusively with the new setup are presented in the videos. The image quality obtained was comparable with the conventional laparoscopic setup, and the operations performed were unaffected.

CONCLUSION:
This report presents the use of a wireless camera throughout the course of a laparoscopic surgery, and the results are promising. The new systems’ favorable characteristics, such as wireless signal transmission, cost, flexibility, and size, support this as a feasible new technique for performing laparoscopic surgery.
Foley Bulb Added to an Oral Misoprostol Induction Protocol
Authors: Adhikari Emily H. , Nelson David B. , McIntire Donald D. , Leveno Kenneth J. 
Published: October 2020

OBJECTIVE:
To evaluate whether the induction of labor in term gravid women with cervical dilation 2 cm or less and intact membranes by using oral misoprostol preceded by transcervical Foley bulb placement results in a significantly increased vaginal delivery rate compared with the use of oral misoprostol alone.

METHODS:
We randomized the induction method by week of admission to labor and delivery, with each week group described as a cluster in a block randomized design. Women with gestational age of 37 weeks or greater, cervical dilation 2 cm or less, intact membranes, and indication for labor induction were included. Study arms were either 100 micrograms of oral misoprostol after transcervical Foley bulb placement or 100 micrograms of oral misoprostol alone. The primary outcome was vaginal delivery with the first induction attempt. Secondary outcomes included time to delivery, clinical chorioamnionitis (maternal temperature of 38°C or greater during labor with or without fundal tenderness, without other identified cause), cesarean delivery indication, and adverse outcomes. We estimated that a sample size of 1,077 per arm was needed to detect a 5% increase in vaginal delivery rate with a type I error of 5% and power of 80%, accounting for interim analysis and cluster size of 30 inductions per week. This was a pragmatic trial, and analysis was by intention-to-treat.

RESULTS:
From January 1, 2018, to May 13, 2019, 1,117 women (34 clusters) were assigned to oral misoprostol plus Foley and 1,110 women (34 clusters) to oral misoprostol alone. Demographic characteristics were similar. Vaginal delivery at the first induction occurred in 78% of the misoprostol plus Foley arm and in 77% of the misoprostol arm (relative risk [RR] 1.00; 95% CI 0.96–1.05; adjusted relative risk [aRR], 1.00; 95% CI 0.95–1.05). Clinical chorioamnionitis occurred in 18% of the misoprostol plus Foley arm and in 14% of the misoprostol arm (RR 1.30; 95% CI 1.07–1.58; aRR 1.30; 95% CI 1.08–1.56). There were no differences in neonatal outcomes.

CONCLUSION:
Induction of labor in gravid women at term with intact membranes by using oral misoprostol plus Foley bulb did not result in a higher vaginal delivery rate, but it did result in more clinical chorioamnionitis compared with the use of oral misoprostol alone.

CLINICAL TRIAL REGISTRATION:
ClinicalTrials.gov, NCT03407625.
Changes in Sexual Activity and Function After Pelvic Organ Prolapse Surgery
Authors: Antosh Danielle D. , Kim-Fine Shunaha , Meriwether Kate V. , Kanter Gregg , Dieter Alexis A. , Mamik Mamta M. , Good Meadow , Singh Ruchira , Alas Alexandriah , Foda Mohamed A. , Balk Ethan M. , Rahn David D. , Rogers Rebecca G. 
Published: October 2020

OBJECTIVE:
We aimed to systematically review the literature to describe sexual activity and function before and after prolapse surgery.

DATA SOURCES:
We searched MEDLINE, EMBASE, and ClinicalTrials.gov databases from inception to April 2018.

METHODS OF STUDY SELECTION:
Prospective, comparative studies of reconstructive pelvic organ prolapse (POP) surgeries that reported sexual function outcomes were included. Studies were extracted for population characteristics, sexual function outcomes, and methodologic quality. Data collected included baseline and postoperative sexual activity, dyspareunia, and validated sexual function questionnaire scores. Change in validated scores were used to categorize overall sexual function as improved, unchanged, or worsened after surgery.

TABULATION, INTEGRATION, AND RESULTS:
The search revealed 3,124 abstracts and identified 74 articles representing 67 original studies. The overall quality of evidence was moderate to high. Studies reporting postoperative results found higher rates of sexual activity than studies reporting preoperative sexual activity in all POP surgeries except sacrospinous suspension, transvaginal mesh, and sacrocolpopexy. The prevalence of dyspareunia decreased after all prolapse surgery types. The risk of de novo dyspareunia ranged from 0% to 9% for all POP surgeries except posterior repair, which lacked sufficient data. Overall sexual function based on PISQ-12 (Pelvic Organ Prolapse/Incontinence Sexual Questionnaire-12) scores improved for mixed native tissue repairs, anterior repairs, uterosacral suspensions, sacrospinous suspensions, and sacrocolpopexy; scores were similar for posterior repairs, transvaginal mesh, and biologic grafts. Sexual function did not worsen after any POP surgeries.

CONCLUSION:
Sexual function improves or remains unchanged after all types of reconstructive POP surgeries and does not worsen for any surgery type. Prevalence of total dyspareunia was lower after all POP surgery types, and de novo dyspareunia was low ranging 0–9%. This information can help surgeons counsel patients preoperatively.

SYSTEMATIC REVIEW REGISTRATION:
PROSPERO, CRD42019124308.
A Framework Proposal for Quality and Safety Measurement in Gynecologic Emergency Care
Authors: Fauconnier Arnaud , Provot Johan , Le Creff Isabelle , Boulkedid Rym , Vendittelli Françoise , Doret-Dion Muriel , Sroussi Jérémy , Giraudet Géraldine , Jacobs Romain , Bourret Antoine , Bauville Estelle , Carvalho Solenn , Tourette Claire , Koskas Martin , Akladios Chérif , Nisolle Michelle , Lejeune Christophe , Huchon Cyrille , Alberti Corinne , Dumont Alexandre , Bouvier-Colle Marie-Hélène 
Published: October 2020

OBJECTIVE:
To define and assess the prevalence of potentially life-threatening gynecologic emergencies among women presenting for acute pelvic pain for the purpose of developing measures to audit quality of care in emergency departments.

METHODS:
We conducted a mixed-methods multicenter study at gynecologic emergency departments in France and Belgium. A modified Delphi procedure was first conducted in 2014 among health care professionals to define relevant combinations of potentially life-threatening conditions and near misses in the field of gynecologic emergency care. A prospective case–cohort study in the spring of 2015 then assessed the prevalence of these potentially life-threatening emergencies and near misses among women of reproductive age presenting for acute pelvic pain. Women in the case group were identified at 21 participating centers. The control group consisted of a sample of women hospitalized for acute pelvic pain not caused by a potentially life-threatening condition and a 10% random sample of outpatients.

RESULTS:
Eight gynecologic emergencies and 17 criteria for near misses were identified using the Delphi procedure. Among the 3,825 women who presented for acute pelvic pain, 130 (3%) were considered to have a potentially life-threatening condition. The most common diagnoses were ectopic pregnancies with severe bleeding (n=54; 42%), complex pelvic inflammatory disease (n=30; 23%), adnexal torsion (n=20; 15%), hemorrhagic miscarriage (n=15; 12%), and severe appendicitis (n=6; 5%). The control group comprised 225 hospitalized women and 381 outpatients. Diagnostic errors occurred more frequently among women with potentially life-threatening emergencies than among either hospitalized (odds ratio [OR] 1.7, 95% CI 1.1–2.7) or outpatient (OR 14.7, 95% CI 8.1–26.8) women in the control group. Of the women with potentially life-threatening conditions, 26 met near-miss criteria compared with six with not potentially life-threatening conditions (OR 25.6, 95% CI 10.9–70.7).

CONCLUSIONS:
Potentially life-threatening gynecologic emergencies are high-risk conditions that may serve as a useful framework to improve quality and safety in emergency care.
Maternal age at last birth and leukocyte telomere length in a nationally representative population of perimenopausal and postmenopausal women
Authors: Latour Chase D. , O’Connell Kelli , Romano Megan E. , Kantor Elizabeth D. , Du Mengmeng 
Published: October 2020

Abstract

Objective:
The primary aim of this study was to evaluate if maternal age at birth of last child is associated with leukocyte telomere length in a nationally representative population of perimenopausal and postmenopausal women.

Methods:
We conducted a cross-sectional analysis of 1,232 women from the National Health and Nutrition Examination Survey to examine maternal age at last birth and telomere length, surveyed between 1999 and 2002. We included perimenopausal and postmenopausal women age 40 years and older. Maternal age at last live birth was self-reported, and leukocyte telomere length was measured using quantitative polymerase chain reaction. We calculated least-squares geometric mean telomere length across categories of maternal age adjusted for age, race/ethnicity, number of live births, survey cycle, and history of hysterectomy or oophorectomy. P trend < 0.05 was considered statistically significant. For hypothesis-generation, we explored modification by reproductive and sociodemographic factors.

Results:
Maternal age at last birth was positively associated with telomere length: the multivariable-adjusted least-squares geometric mean leukocyte telomere length across categories of age at last birth (<25, 25-29, 30-34, 35-39, ≥40 y) was 0.90, 0.93, 0.93, 0.95, and 0.96, respectively (P trend = 0.04). There was suggestive evidence this association may be restricted to those women with one or two live births or women who reported ever using oral contraceptives (P interaction <0.10 for both).

Conclusions:
Later maternal age was associated with longer telomere length in a nationally representative population of women. These data provide new insight into the biological relationship between reproductive history and long-term health.

Video Summary:

http://links.lww.com/MENO/A662.