bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Sleep Quality in Month Prior to Delivery as It Relates to Breastfeeding [23O]
Authors: Herrine Gail , Fuhrman Sara , Washio Yukiko 
Published: April 2020

INTRODUCTION:
The World Health Organization and the American College of Obstetrics and Gynecology encourage exclusive breastfeeding as the best nutritional intake for newborns for the first six months of life. Little evidence exists on how maternal sleep quality may relate to breastfeeding, particularly in underserved populations. Our study investigates correlations between maternal sleep quality, breastfeeding intention, and breastfeeding experience during hospital stay after delivery.

METHODS:
After obtaining institutional review board approval, we interviewed 122 mothers who recently delivered in an urban hospital setting regarding breastfeeding history, breastfeeding intention, and maternal sleep quality in the last month of pregnancy (assessed via Pittsburgh Sleep Quality Index [PSQI] questionnaire). Interviews were completed via surveys on the postpartum floors of maternity units in the mid-Atlantic region.

RESULTS:
Mothers were on average 26.0 years old, had 12.3 years of schooling, 42.1% identified as Hispanic, 30.3% identified as black/African American, and 78.5% were receiving Medicaid. We found that previous breastfeeding experience and intention to breastfeed positively correlated with PSQI scores during the last month of pregnancy (P=.095 P=.067, respectively). Specifically, Component 5 measuring sleep disturbances correlated with both previous breastfeeding experience and the intention to breastfeed (P=.027 P=.038, respectively).

CONCLUSION:
Our work indicates an association between breastfeeding and poor sleep quality during the last month of pregnancy, suggesting sleep disturbance is not a barrier for new mothers to breastfeeding. Further research will be needed to clarify and expand on the relationship between breastfeeding and sleep, particularly with regard to sleep environment and sleep hygiene.
Patients With Low Socioeconomic Status More Likely to Present for Non-Elective Ovarian Cancer Surgery [34H]
Authors: Rudasill Sarah E. , Budker Rachel , Mardock Alexandra L. , Bellamkonda Nikhil , Cohen Joshua G. 
Published: April 2020

INTRODUCTION:
Non-elective surgery, performed less than 24 hours after presentation, is not well described in patients with gynecologic malignancy. Using the National Readmissions Database (NRD), we characterized non-elective hospital admissions for patients undergoing ovarian cancer surgery.

METHODS:
We evaluated the NRD for patients undergoing ovarian cancer surgery between 2010 and September 2015. Primary outcome was characterizing demographics and comorbidities of patients presenting non-electively. Secondary outcomes were mortality, length of stay (LOS), and adjusted costs at index hospitalization, as well as 30-day readmission rates. Multivariable analysis identified predictors and outcomes of non-elective presentation.

RESULTS:
Of 45,572 patients undergoing ovarian cancer surgery, 9,136 (20.1%) were classified as non-elective. Non-elective patients had a higher average Elixhauser comorbidity index (3.6 vs. 3.2, P<.001), greater Medicaid coverage (14.0 vs. 6.5%, P<.001), and reduced private insurance coverage (37.5 vs. 47.3%, P<.001) relative to elective patients. Multivariable analysis revealed that patients presenting non-electively had higher mortality (OR 3.00 [95% Confidence Interval (CI) 2.37-3.81]) and 30-day readmission rates (OR 1.30 [1.20-1.41]) than elective patients. After adjustment, non-elective patients spent 3.3 more days in the hospital [95% CI 3.1-3.6]) with $6,396 more in adjusted costs [95% CI $5,667-7,125]. Significant predictors of non-elective admission included lowest income quartile relative to highest (OR 1.43 [1.28-1.61]) and age less than 50 relative to age 50-69 (OR 1.52 [1.41-1.64]).

CONCLUSION:
The rate of non-elective ovarian cancer surgery remains high, with increased patient mortality and resource utilization. An independent association between lower income and higher rates of non-elective surgery was observed, highlighting the need to address low socioeconomic populations to prevent emergent hospitalization.
Preoperative and Perioperative Analgesia/Anesthesia in Ovarian Cancer Patients: Correlation With Recurrence [36H]
Authors: Podwika Sarah , Bosch Allison , Gammon Elizabeth , Modesitt Susan 
Published: April 2020

INTRODUCTION:
Prior breast cancer studies demonstrated an association between beta blockers and nonsteroidal medication in disease-free survival, possibly due to immune interactions. This hypothesis-generating retrospective study evaluated the association between ovarian cancer recurrence and baseline medication use (aspirin, acetaminophen, nonsteroidals, beta blockers, or antidepressants) and the perioperative medication (Tylenol, NSAIDs and regional analgesia) administration.

METHODS:
After IRB approval, a retrospective chart review of an academic medical center’s pathology database and ovarian cancer registry was performed to evaluate medication administration and recurrence.

RESULTS:
284 women with ovarian cancer were included (mean age 62 years). At point of last contact, 34.2% were alive without recurrence, 15.7% were alive with disease, 43.1% had died of disease, and 7% unknown. 61.2% had cancer recurrence. Mean time from surgery to recurrence was 23.7 months (4.4-132.5 +/- 20). There was no statistically significant difference in baseline use of beta blockers (P=.076), aspirin (P=.29), acetaminophen (P=.67), NSAIDs (P=.78) or anti-depressants (P=.96). There was no statistically significant difference between perioperative medication use and recurrence, regional anesthesia (P=.12), beta-blocker (P=.93), acetaminophen (P=.68), and nonsteroidals (P=.12). Women who recurred were older (59.5 vs 63.7 years, P<.01) and had higher CA-125 (93.6% vs 6.4%, P<.01) at diagnosis. Of the medications evaluated, antidepressants showed the only statistically significant difference in progression free survival (PFS), (70 vs 77 months, P=.008).

CONCLUSION:
Outside of the association of antidepressant use with worse PFS, there was no statistically significant difference in disease recurrence based on baseline or perioperative analgesic medication use.
Prevalence on Synchronic Ovarian and Endometrial Cancer in the San Borja Arriaran Hospital From 2016 to 2019 [38H]
Authors: Cervantes Pedro , Altamirano-Assad Roberto , Nazzal Omar 
Published: April 2020

INTRODUCTION:
Synchronous endometrial and ovarian cancer are relatively rare in the general population. It ranges from 3.1% –10.0% of patients with endometrial cancer and 10% of patients with ovarian cancer.

METHODS:
Retrospective review with statistical database analysis using: clinical records, protocols, biopsies and gynecologic-oncological committee records of patients diagnosed with ovarian and endometrial cancer between December 2014 and June 2019. Only patients with synchronous endometrial cancer were included and ovary regardless of histological type.

RESULTS:
A total of 317 patients were selected, 177 with endometrial cancer and 140 with ovarian cancer. 12 patients diagnosed with synchronous endometrial and ovarian cancer, with a median age of 58.1 years. Endometrial carcinomas were found in FIGO stage IA 75%, IB 8.3%, IIIA 16.6%. Histological type 83.3% endometrioid and 16.6% mixed. As for ovarian carcinomas, 83.3% were of epithelial and 16.6% were granulosa cells tumors. Stage FIGO IA 50%, IC 8.3%, IIA 41.6%. A prevalence of synchronous tumors was found in 6.7% of endometrial cancer 8.5% of ovarian cancer.

CONCLUSION:
Synchronous endometrial and ovarian cancers included in this study were presented in early stages, well differentiated and their prevalence was similar to international literature. Although they are rare, it is necessary to consider their existence.
The Impact of Patient Frailty on Readmission Morbidity and Mortality in Women Undergoing Ovarian Cancer Surgery [39H]
Authors: Sia Tiffany , Wen Timothy , Cham Stephanie , Friedman Alexander , Wright Jason 
Published: April 2020

INTRODUCTION:
Frailty, defined as loss of reserve and vulnerability to changes in health, affects many elderly patients. We investigated the effect of frailty on readmission and mortality rates in patients undergoing laparotomy for ovarian cancer.

METHODS:
Patients underwent laparotomy between 2010-2014 were identified using the Nationwide Readmissions Database. Frailty was identified using the Johns Hopkins Adjusted Clinical Groups Frailty Indicator, which requires 1 of 10 frailty defining diagnoses. Univariable and multivariable log linear regression analyses were conducted to analyze the association between frailty and 30-day and 90-day all cause readmission and mortality. Models were adjusted by patient, hospital, and clinical factors.

RESULTS:
We identified 78,821 cases. Frailty affected 5.8% of patients. 30-day and 90-day readmission rates were 14.6% and 24.2%, respectively, with readmission mortality rates of 3.4% and 3.3% for 30- and 90-day readmissions. Frailty was independently associated with an 11% increased risk for both 30-day and 90-day readmission. Frailty was also associated with a 34% increased risk of mortality when readmitted at 90-days (RR 1.34, 95% CI 1.04-1.72, P=.02). Having two or more comorbid conditions, discharge to nursing facility, intermediate care facility or home health care, leaving against medical advice, receiving a postoperative blood transfusion, and having a medical or surgical complication increased the risk of 30- and 90-day readmissions and mortality at the time of readmission.

CONCLUSION:
Frailty is associated with an increased risk of readmission and a higher rate of mortality and should be considered when planning for ovarian cancer surgery.
Upstream Gynecology: Identifying Social Determinants of Health in a Gynecologic Oncology Population [40H]
Authors: Nora Anne , Haugsdal Michael L. 
Published: April 2020

INTRODUCTION:
Social determinants of health (SDoH) are factors that affect a patient’s health quality and outcomes. Evidence suggests that clinical care contributes only 20% to patient outcomes, while the remainder is under the influence of upstream factors. The upstream approach to healthcare aims to address SDoH before they contribute to less ideal outcomes downstream. Several social determinants of health may contribute to outcomes for cancer patients. This Upstream Gynecologic Oncology Initiative seeks to identify which SDoH affect patients with gynecologic malignancies.

METHODS:
This needs assessment is the first step in a quality improvement project assessing the SDoH affecting women with gynecologic cancers. Female patients receiving care for gynecologic malignancies were invited to complete an anonymous needs assessment survey. Validated survey questions regarding housing, food, transportation, finances, health literacy and social support were used to identify needs. Data collected is being used to further develop a routine screening tool and to organize resources specific to the identified needs.

RESULTS:
Results demonstrate the relative prevalence of existing SDoH needs upstream of clinical care within this unique gynecologic oncology patient population. Results from the study population are also compared to prevalence among the general population of this institution's state.

CONCLUSION:
Upstream SDoH are identified to be present and likely contributing to health quality and outcomes within this gynecologic oncology patient population. Appreciation and assessment of their potential to impact care and management can be used to design a routine screening tool for the study population and organize resources to address or mitigate the identified needs.
“Is the Pre-cum Myth True?” An Analysis of Queries on Using Withdrawal for Contraception on Reddit [02I]
Authors: Latack Kyle , Patel Jasmine , Moog Dominic , Spencer Donovan , Nguyen Brian T. 
Published: April 2020

INTRODUCTION:
Limited research and the lack of guidelines on “withdrawal” or coitus interruptus lead to inconsistent provider-patient recommendations regarding its use. Patients consequently rely on peers or online communities to learn about this neglected contraceptive method. To better understand knowledge gaps and concerns, we examined posts about withdrawal on the popular, anonymous internet discussion forum, Reddit.

METHODS:
Posts containing the search terms: “coitus interruptus,” “withdrawal,” “pull out,” “pre-ejaculate,” or “pre-cum” were extracted and filtered for relevant content. Data extraction was limited to gendered forums/subreddits from 2010-2019: “TwoXChromosomes,” “Askwomen,” “Askmen,” “OneY.” We developed an initial codebook with expected themes, augmented with salient themes emerging from a random sampling of 10% of posts, and revised iteratively until adequate inter-rater agreement was reached; remaining posts were coded independently.

RESULTS:
Of 271 withdrawal-related queries, 19% were submitted by men; 81% referenced the contributor’s own use of withdrawal. Salient themes included: concerns about pregnancy risk (52%), using withdrawal with additional contraception (49%), impact on personal life/relationship (27%), benefits/pleasure from using withdrawal (12%), when or how to effectively use withdrawal (7%), and problems encountered (3%). Posts to female-focused forums more frequently inquired about pregnancy risk, while those on men’s forums inquired about when/how to use withdrawal (P<.01); themes were not associated with contributor gender.

CONCLUSION:
Withdrawal-related queries on Reddit are more frequently posted by women, the majority of whom want to better understand their risk of pregnancy with withdrawal. Research on operationalizing withdrawal and withdrawal-related pregnancy risk may help providers counsel patients and decrease their reliance on online forums.
Awareness and Accessibility of Contraception [08I]
Authors: Lee David , Cheng Abigail W. , Swayze Emma , Jones Alexis , Ellis Monica , Newbery Gisella 
Published: April 2020

INTRODUCTION:
Our study sought to assess community member attitudes toward newly-acquired immediate postpartum long-acting reversible contraception (IPLARC) benefits and determine whether a lack of knowledge about contraception may be impacting their attitudes. Prior literature has extensively detailed contraceptive methods, impacts contraception has on at-risk populations, and inquiries regarding implementation of IPLARCs prior to inclusion under insurance benefits. Recently, studies from South Carolina and Georgia published proposals for implementation from provider and institutional perspectives, though no assessment of patient knowledge was conducted.

METHODS:
An electronic 8-question survey was administered to Western Michigan University School of Medicine (WMed) clinic visitors and data was recorded via REDCap database. Individuals ≥18 and <60 years of age and were English-speaking were included. This study was exempted by the WMed Institutional Review Board.

RESULTS:
107 submissions were completed. 100% self-reported familiarity with and ability to explain to a friend ≥1 forms of contraception. 97.2% reported experience using ≥1 forms of contraception, with 42.06% either previously or currently using a LARC. However, only 22.43% responded they were interested in IPLARCs if they got pregnant, 63.55% said they were not interested, and 14.02% were uncertain as they had never been pregnant.

CONCLUSION:
Respondents were generally knowledgeable about and experienced with contraception and their low receptiveness towards IPLARCs unlikely stems from ignorance regarding contraception. Additional factors including health literacy, psychosocial factors, and prior experiences with contraception likely also impacted their attitudes. These should be further explored to best position patients to make informed decisions regarding their reproductive health.
Barriers to Obtaining Long-Acting Reversible Contraception Among Low-Income Women [09I]
Authors: Henke Leah , Martins Summer , Boraas Christy 
Published: April 2020

INTRODUCTION:
Low-income women in the United States shoulder a disproportionate burden of unintended pregnancy, reflecting possible difficulties in accessing contraception. We examined the association between income and barriers to obtaining long-acting reversible contraception (LARC).

METHODS:
Non-pregnant women aged 18 to 40 years completed an electronic, cross-sectional survey at the University of Minnesota Driven to Discover Research Facility at the Minnesota State Fair in 2018. Participants reported being biologically capable of pregnancy and sexually active with a male partner. Bivariate analyses examined perceptions of LARC, barriers to LARC, and LARC use by participants’ income status: low income (less than or equal to 200% of federal poverty guideline) versus higher income. This study was deemed IRB exempt.

RESULTS:
Low-income women (n=91) were more likely than higher income women (n=274) to encounter at least one perceived barrier to obtaining a LARC method (70% vs 47%, P<.01), to identify more concerns about LARC use (3.1 vs 2.5, P<.01), and note more bothersome side effects (4.2 vs 3.5, P=.02). Cost of LARC was the most frequently identified barrier and was of greater concern to low-income women (53% vs 32%, P<.01). However, there was a trend toward low-income women being less likely to choose LARC as their preferred method even if cost barriers were removed (35% vs 46% P=.06).

CONCLUSION:
Low-income women experience more barriers to access but also more negative perceptions of LARC. Efforts to increase access to LARC should address these barriers and focus on concerns more common among low-income women regarding LARC use.
Deeply Inserted Contraceptive Implants: Where Are They Placed? Experience From a University Hospital Center [12I]
Authors: Xu Liwen , Korotkaya Yelena , Rible Radhika 
Published: April 2020

INTRODUCTION:
We describe our experience in a Family Planning specialty clinic for patients referred for nonpalpable or deep etonogestrel (ENG) implant removal.

METHODS:
We reviewed the charts of 77 patients evaluated for difficult ENG implant removal from September 2014 through September 2019. In our clinic, we localize implants using high-frequency ultrasound and then proceed with removal under local anesthesia.

RESULTS:
Most implants were placed in reproductive health clinics (n=26; 34%) and community clinics (n=16; 21%) versus academic medical centers (n=6; 8%) and abroad (n=4; 5%). 25 patients (32%) did not recall where their implant was inserted. We successfully removed 72 implants (94%; 45 suprafascial, 27 subfascial) in the office; one subfascial implant was removed in the OR and four were lost to follow up. Non-obese patients were more likely to have a subfascial implant (36/51) than obese patients (3/24; P=.0014). Nonpalpable subfascial implants were also more likely to be found in individuals with BMI<30 (19/21, P=.0004). Of the patients not desiring immediate pregnancy (n=64), 17% chose another implant (n=11), 16% picked a different LARC method (n=10), 38% chose a combined hormonal contraceptive method (n=24), and 28% opted for condoms or nothing for contraception (n=18).

CONCLUSION:
In our patient population, most had their implants placed at reproductive health or community clinics. Deeply inserted implants can be successfully removed in the office by experienced providers and many patients choose to continue with the implant for contraception despite complications.
Does Education Promote Acceptance?: Perceptions of Emergency Contraception on the U.S.-Mexico Border [13I]
Authors: Wong Melissa L. , Smith Theresa , Hinshaw Shirley J. , Bracamontes Christina G. , Mulla Zuber 
Published: April 2020

INTRODUCTION:
Given the high unintended pregnancy rate and infrequent use of emergency contraception (EC) in the U.S., it is imperative that providers investigate patients’ beliefs regarding EC. This study’s aim was to assess the impact of EC patient education on knowledge of and willingness to use EC.

METHODS:
75 women ages 18-50 years were recruited from university clinics in El Paso, a multicultural city on the U.S.-Mexico border. IRB approval was obtained and participants underwent informed consent. Knowledge of EC was measured before and after subjects watched an educational video. Adjusted odds ratios for patients’ knowledge post-intervention were calculated from logistic regression models using Firth’s bias-reducing penalized likelihood.

RESULTS:
The average participant’s age was 28.4 years and 82.7% self-identified as Hispanic. Before watching the video, 30.7% of participants answered that EC would only work before implantation, and this proportion increased to 37.0% after the video. Women with moderate religious beliefs were less likely than women without very strong religious beliefs or with none at all to correctly identify that EC works before implantation occurs (OR 0.21, P=.03). 21.3% of subjects initially stated that they considered an abortion to be interrupting pregnancy after implantation occurs, whereas 37.8% conveyed the same opinion after the video. Prior to the educational intervention, 17.6% of patients reported they would never use EC, and after the video, this figure was 16.2% (P=.71).

CONCLUSION:
Women with moderately strong religious beliefs were less likely to correctly identify EC’s mechanism of action. The educational intervention did not significantly affect participants’ willingness to use EC.
Double-Blinded, Randomized, Placebo-Controlled Trial of Multimodal Analgesia at Intrauterine Device Insertion [15I]
Authors: Zdroik Anna V. , Kirsten Phillips , Dhanraj Dave , Devaiah Ganga , Corona Samaris , Crisp Catrina C. 
Published: April 2020

INTRODUCTION:
The utilization of long acting reversible contraception has remained low. Pain and anxiety associated with intrauterine device (IUD) placement are barriers. The purpose of this study was to investigate the effects of cervical lidocaine injections and oral diazepam on pain and anxiety during office IUD insertion.

METHODS:
Following Institutional Review Board approval, subjects desiring IUD placement were randomized to diazepam 5 mg orally with cervical injections of 2.5 ml of 2% lidocaine or placebo pill with saline injections. Both groups received 800 mg oral Ibuprofen. Providers and subjects were blinded to their assigned group. Primary outcome was pain on a visual analog scale at various steps of IUD insertion. Power analysis set enrollment at 58, which is ongoing.

RESULTS:
At interim analysis, a total of 41 women have been enrolled. Of these, 39 (20 in the study arm, 19 in the placebo arm) underwent IUD insertion. Median anxiety was significantly decreased when placing the speculum in the study arm compared to placebo (5.5 mm vs. 31 mm; P=.004) respectively. Additionally, subjects in the intervention group reported lower pain scores during insertion of the IUD (24 mm vs. 71 mm, P=.030).

CONCLUSION:
At interim analysis, oral diazepam and cervical lidocaine injections compared to placebo show clinically significant decreases in anxiety and pain during IUD placement. If these early results are confirmed, the use of cervical lidocaine injections and oral diazepam may provide additional tools to help increase utilization of IUDs by decreasing pain and anxiety associated with insertion.