bluuebunny/crossref_metadata_2025_split huggingface dataset:
Implementation of GBS Self-Swabbing Protocol at the Women's Institute at Banner University Medical Center—Phoenix [21N]
Authors: Gilbert Molly , Cheney Megan Clair , Gerkin Richard 
Published: April 2020

INTRODUCTION:
To implement a group B streptococcus (GBS) self-swabbing protocol at The Women's Institute and to determine patient satisfaction in self-swabbing. Secondarily, to confirm physician and patient-collected swabs yield similar rates of GBS colonization.

METHODS:
This is a prospective quality project. Patients were provided the option to self-swab for GBS at their 35 to 37 week visit from January 3 to July 12, 2019. The patient was consented and educated on how to perform the swab. They then completed a short, three question survey to evaluate comfort and satisfaction. A retrospective chart review was performed from September 1, 2018 to July 12, 2019 to determine GBS colonization rates of provider-collected swabs.

RESULTS:
The rate of GBS colonization in patient-collected swabs was 14/67 (20.9%). Most patients felt comfortable performing the swab (92.5% CI 83.4–97.5%), felt educated in how to perform the swab (98.5% CI 92.0–100.0%), and either preferred to self-swab or had no preference of who performed future swabs (94.0% CI 85.4–98.4%). A retrospective chart review determined the rate of GBS colonization to be 47/238 (19.8%) in provider-collected swabs, which was not significantly different (19.8 vs 20.9, P .86) from patient-collected swabs.

CONCLUSION:
The rate of GBS colonization between patient and provider-collected swabs was not significantly different, which is consistent with prior studies. Survey results demonstrated patient satisfaction and comfort performing the self-swab. This study supports providing our patients the option of self-swabbing for GBS.
Clinical Presentation and Management of Nephrolithiasis in the Obstetric Patient: A Matched Cohort Study [07N]
Authors: Sebastian Natasha , Abenhaim Haim Arie , Spence Andrea , Czuzoj-Shulman Nicholas 
Published: April 2020

INTRODUCTION:
Nephrolithiasis is a common medical condition, but little is known about its occurrence in pregnant patients. The study objective is to compare the clinical presentation and management of nephrolithiasis in pregnant women compared with non-pregnant women.

METHODS:
A retrospective matched-cohort study was conducted using the United States' Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database from 1999 to 2015. ICD-9 coding was used to identify women with nephrolithiasis within this cohort. Pregnant women with nephrolithiasis were identified and age matched (1:1) to non-pregnant women with nephrolithiasis. Conditional logistic regression, adjusted for baseline characteristics, was used to compare the clinical presentation and management of nephrolithiasis in pregnant versus non-pregnant women.

RESULTS:
There were 30,006 pregnant patients with nephrolithiasis in the cohort. Pregnant women, relative to non-pregnant women, were more likely to be treated in urban teaching hospitals and to have private health insurance. Pregnant patients were less likely to present with classic clinical symptoms of nephrolithiasis, such as flank pain, OR 0.48 (95% CI 0.45–0.53), hematuria, 0.79 (0.73–0.86), and fever, 0.17 (0.13–0.22). Pregnant patients displayed shorter lengths of stay in hospital (3 days or more, 0.81 (0.78–0.84) and were less likely to be affected by infectious conditions, namely urinary tract infections, 0.56 (0.53–0.58), sepsis, 0.14 (0.12–0.16), and pyelonephritis, 0.38 (0.36–0.42). All invasive and surgical procedures were more frequently practiced in the non-pregnant group.

CONCLUSION:
Pregnant women admitted with nephrolithiasis appear to have a milder disease course as compared to age-matched non-pregnant women, likely suggesting better access to care and a lower threshold for admission.
Non-Obstetric Surgery During Pregnancy [24N]
Authors: Spiegel Strauss Tirtza N. , Goldberg Gary 
Published: April 2020

INTRODUCTION:
Non-obstetric surgery is performed every 2 in 1000 pregnancies. With the increase in minimally invasive surgery, we aimed to review the surgery performed and the incidence of complications.

METHODS:
We conducted a 5 year institutional review of non-obstetric surgery in pregnancy. Patient demographics, procedure, indication, admission length, complications and delivery mode were collected. Descriptive analyses and student's t tests were performed to evaluate associations between gestational age, procedure type, presence of complications, mode and timing of delivery.

RESULTS:
From 2015–2019, 87 pregnant women underwent non-obstetric surgery at our tertiary care academic center. The mean age was 30.9 years and the mean weight was 83.4 kg. 45/87 surgical procedures (51.7%) were performed during the second trimester. 56/87 were general surgical procedures (64.3%) and 19 (21.8%) were performed for gynecologic indications. 83/84 had benign disease. 78.1% were laparoscopic surgeries and 68/87 (78.1%) patients were discharged the following day. 9/87 patients (10%) had a complication: infection (3), VTE (1), hospital re-admission (2) and preterm labor (3). 3 women miscarried (3.4%). Thirteen women experienced later complications in pregnancy. 4 women (4.5%) had intra-uterine fetal deaths and 10 had preterm births (10.5%). Most women had vaginal deliveries. Delivery mode was not significantly associated with surgical procedure or gestational age at time of surgery.

CONCLUSION:
Our data suggests that non-obstetric surgery during pregnancy is relatively safe. Minimally invasive surgery was performed in most cases. The immediate pregnancy loss of 3.4% was low and the overall surgical complication rate was low. The most common adverse outcome was preterm birth.
The Prevalence of Expired GBS Screens Among Women Delivering at Term [36N]
Authors: Guzman Colleena , Howard David 
Published: April 2020

INTRODUCTION:
A 2019 committee opinion from the American College of Obstetrics and Gynecology [ACOG] recommended delaying the antenatal GBS screen until 36–37 weeks to reduce the number of women delivering at term with an expired GBS screen. The purpose of this pilot study was to determine, in a large private practice setting, the proportion of women delivering at term (37 weeks or greater) with an expired GBS negative screen.

METHODS:
We retrospectively examined the charts of all women in a large multispecialty practice in Nevada who delivered between January 1 and June 30, 2018.

RESULTS:
We initially examined 199 charts. The median gestational age at delivery was 39.1 weeks (IQR 38.4 to 40 weeks). The median age of our study population was 30 (IQR 24 to 33 yrs). There were 149 patients who had a documented GBS result and of these 149 patients, 123 (82.5%) had a negative GBS screen. There were 103 patients who delivered at term, were GBS negative at their initial screen, and for whom both delivery date and GBS screen date were available. Among this subgroup, 9 patients had an interval greater than 35 days (8.74%). These 9 patients had GBS screen-to-delivery intervals of 36 (n=5), 37 (n=1), 39 (n=2), and 49 days (n=1), respectively.

CONCLUSION:
We found that approximately 1 out of 11 women in our practice delivered at term with an expired GBS screen. If our results are replicated in larger studies, it would provide further evidence to support the recent ACOG recommendations to delay GBS screening to 36–37 weeks.
Accuracy of Maternal Substance Use History Among Infants at Risk of Neonatal Abstinence Syndrome [02O]
Authors: Humphreys Meredith , Smid Marcela Carolina , Gavin Erin , Fung Camille , Johnson Erin , Allshouse Amanda A. 
Published: April 2020

INTRODUCTION:
Prenatal substance exposure increases risk of neonatal abstinence syndrome (NAS). The objective of this study was to determine the concordance between documented maternal substance use history and neonatal results among mother-infant dyads at risk of NAS.

METHODS:
We performed a retrospective chart review of mother-infant dyads at risk for NAS, defined as those infants receiving neonatal withdrawal inventory scores. We included those dyads with available maternal charts and infant biological testing (meconium or cord toxicology results). Maternal substance use defined as maternal reported use or positive urine toxicology. We excluded multiple gestation and preterm infants (<37 weeks). We calculated positive predictive value (PPV), negative predictive value (NPV) and accuracy of maternal history of opioid, stimulant, marijuana and anti-depressant use with infant biological results. IRB approval was obtained.

RESULTS:
From May 2017–May 2018, 197 dyads met study criteria. Maternal opioid history (n=135, 69%) had PPV 83.7% (95% CI 78.6–87.8%), NPV 56.5% (95% CI 46.6–65.8%) and accuracy 75.1% (95% CI 68.5–81%). Maternal stimulant history (n=91, 46%) had PPV 58.2% (95% CI 51.2–64.9%), NPV 94.3% (95% CI 88.6–97.3%) and accuracy 77.6% (95% CI 72.2–83.3%). Maternal marijuana history (n=65, 33%) had PPV 42.4% (95% CI 35.7–49.3) and accuracy 80.7% (95% CI 74.5–85.9%) (NPV could not be calculated). Maternal anti-depressant history (n=52, 26%) had PPV 59.0% (95% CI 47.2–70.0%), NPV 99.4% (95% CI 95.8–99.9%) and accuracy 91.4% (95% CI 86.5–94.9%).

CONCLUSION:
Maternal history and infant biological testing accuracy varies by substance and may miss up to a quarter of infants at risk of NAS. Improved screening procedures for maternal substance use are needed.
Original Research: Exploring the Effects of a Nurse-Initiated Diary Intervention on Post–Critical Care Posttraumatic Stress Disorder
Authors: Torres Lorrie , Nelson Francine , West Gordon 
Published: April 2020

ABSTRACT

Background:
Critical illness survivors may develop posttraumatic stress disorder (PTSD) following critical illness and hospitalization. Left untreated, PTSD may result in poor health outcomes.

Purpose:
This study sought to examine the effects of a nurse-initiated diary intervention on PTSD development and symptom severity in critical illness survivors with varying levels of mentation.

Methods:
The study used a pretest–posttest control group design. Patients who were hospitalized in a critical care unit for more than 24 hours were recruited at a single medical center with two such units. All participants completed a pretest on day 2 of critical care hospitalization; the intervention group participants also received a diary. All participants received a posttest one month after critical care discharge. The variables examined were PTSD severity and symptoms of avoidance, intrusion, and hyperarousal. Variables were measured using the Impact of Event Scale–Revised. Diaries were written by the patient, visitors, and interdisciplinary team members, and kept by the patient.

Results:
A total of 134 participants completed the study. The intervention group participants experienced significantly fewer PTSD symptoms than the control group participants. PTSD was found to be of concern in 35 (26%) of all participants: five in the intervention group and 30 in the control group.

Conclusions:
For critical illness survivors, a collaborative diary-writing intervention during hospitalization and after discharge can mitigate post–critical care PTSD. Participants who received diaries had a lower incidence of PTSD symptoms than controls; and at follow-up, they indicated that the diary intervention was worthwhile. We recommend the use of collaborative diary writing to help critical illness survivors in working through their experiences.
CE: Managing Pain in Critically Ill Adults: A Holistic Approach
Authors: Delgado Sarah A. 
Published: April 2020

ABSTRACT:
Nurses caring for critically ill adults are challenged to balance patient comfort with the risk of complications associated with analgesic therapy. Evidence gathered since 2013, when the Society of Critical Care Medicine (SCCM) published the Clinical Practice Guidelines for the Management of Pain, Agitation, and Delirium in Adult Patients in the Intensive Care Unit, known as the PAD guidelines, gave rise to the SCCM 2018 publication of the Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU, known as the PADIS guidelines. This article discusses how the PADIS guidelines go beyond the PAD guidelines, providing specific guidance related to risk factors for pain, the assessment and management of pain in critical illness, and the ways in which the experience of pain in critical illness is intertwined with that of agitation, delirium, immobility, and sleep disruption. Tables summarize the key points in the PADIS guidelines, clarify the distinctions between PADIS and PAD, and describe the implications for nurses.
Caring for Visually Impaired Patients in the Hospital: A Multidisciplinary Quality Improvement Project
Authors: Carlson Christine , Howe Tami , Pedersen Chase , Yoder Linda H. 
Published: April 2020

ABSTRACTBackground:People with low vision or blindness may experience anxiety, fear, and depression—sometimes severe—as a result of the challenges encountered when they seek medical care. Such patients deserve, and health care professionals must provide, equal opportunities to participate in and benefit from their health care in a safe environment. A search of the literature yielded information on the needs of visually impaired people but failed to find a comprehensive program that health care facilities could use to meet the needs of this vulnerable population. This gap in the literature on visually impaired patients (VIPs) and implications for their care led us to conduct focused meetings with this population.Objective:The specific aims of this quality improvement (QI) project were to determine the needs of hospitalized VIPs, develop educational and other resources that would help clinicians and ancillary hospital staff in their interactions with VIPs, and assemble a toolbox of useful materials for VIPs themselves.Methods:A VIP care team identified the needs of VIPs as reported in the literature and in personal meetings with visually impaired people in the community. The team also surveyed interdisciplinary hospital staff members to determine their experience in caring for VIPs as well as their educational needs, and then developed strategies and educational modules to help clinicians and ancillary staff members accommodate the unique needs of VIPs in accordance with the Americans with Disabilities Act of 1990. The team also assembled a VIP toolbox that contained several items useful to VIPs themselves. Supplementary information tailored to the function of each hospital department (such as nursing, admissions, environmental services, dietary, and radiology) was also provided to help staff members improve VIPs' hospital experience.Results:The hospital's interdisciplinary staff members participated in an education program to improve their care of VIPs. Before the program, only 23.6% of 161 staff members reported having received education on caring for VIPs. After the program, however, 56.4% of 140 staff members reported having received such education. Former patients requested bracelets and room identifiers that would alert staff members to VIPs' needs, and the team provided these. The team also introduced a braille version of the hospital menu and provided VIP toolboxes at each nursing station that contained many useful daily care items.Conclusions:VIPs have specific needs when hospitalized. Patients' and staff members' responses to this QI project were overwhelmingly positive; both groups were appreciative of the newly implemented initiatives to meet the special needs of the visually impaired.
A Randomized Controlled Comparison of Epidural Analgesia Onset Time and Adverse Reactions During Labor With Different Dose Combinations of Bupivacaine and Sufentanil
Authors: Wang Tingting , Lu Yaojun , Zhou Peiwen , Huang Shaoqiang , Yu Xinhua 
Published: April 2020

Objectives:
The purpose was to compare the effects of 3 different dose combinations of bupivacaine and sufentanil on the onset of analgesia and the occurrence of side effects.

Materials and Methods:
One hundred sixty-nine pregnant women were randomly assigned to 3 groups: the B1S5 group received 0.1% bupivacaine+5 μg sufentanil in 15 mL; the B125S5 group received 0.125% bupivacaine+5 μg sufentanil in 15 mL; and the B1S10 group received 0.1% bupivacaine+10 μg sufentanil in 15 mL. The primary outcome was the analgesic onset time, and the secondary outcomes were mode of delivery, patient satisfaction, maternal and neonatal side effects (pruritus, hypotension, sedation, motor block, decreased fetal heart rate, fever, and interference with breastfeeding).

Results:
The median (inter-quartile range) time to achieve effective analgesia was significantly faster in the B125S5 group than in the B1S5 group (10 [11-14 {4-30}] min vs. 15 [17-20 {5-30}] min, P<0.001). There was no significant difference in the analgesia onset time between the B1S10 and B125S5 groups (10 [11-14 {4-30}] min vs. 12 [13-15 {3-30}] min, P=0.202). Pruritus, hypotension, motor block, maternal satisfaction, delivery mode, decreased fetal heart rate, total bupivacaine dose and breastfeeding scores were not significantly different among the 3 groups except the sufentanil dosage and incidence of mild drowsiness and fever (the B1S10 group had significantly higher fever than the other groups).

Discussion:
The B125S5 combination may be superior to the B1S5 and B1S10 combinations as an initial dose for epidural analgesia to achieve rapid effective analgesia with minimal side effects.
Aging Women and the Office Assessment
Authors: Miller Myron 
Published: April 2020

Abstract:
This monograph is intended to serve as a practical guide to the office assessment of the aging woman and recognizes the time constraints that characterize current office practice. Obstetrician–gynecologists are increasingly becoming the primary care providers to women in their practices and especially to older women who have been long-time patients. This monograph should serve as a guide to the many tools needed to assess the health and functional and cognitive status of the aging woman. Illustrative cases demonstrate how to use these tools in a time-efficient manner to achieve a positive effect on the well-being of the patient.
Development of Abbreviated Versions of the Word Auditory Recognition and Recall Measure
Authors: Smith Sherri L. , Ryan David B. , Pichora-Fuller M. Kathleen 
Published: April 2020

Objectives:
The objective of this study was to develop and evaluate abbreviated versions of the Word Auditory Recognition and Recall Measure (WARRM) as part of an iterative process in the development of a feasible test for potential future clinical use.

Design:
The three original WARRM (O-WARRM) randomizations were modified by altering the presentation paradigm. Instead of presenting 5 trials per set size with set size increasing from 2 to 6 as in the O-WARRM (n = 100 words), the experimental WARRM (E-WARRM) paradigm consisted of one trial from each of set sizes 2 to 6 to create a “run” (n = 20 words) with each randomization consisting of 5 runs (n = 100 words). A total of 24 younger listeners with normal hearing and 48 older listeners with hearing loss (OHL) were administered 1 randomization of the O-WARRM and 1 different randomization of the E-WARRM.

Results:
The recognition and recall performances on the O-WARRM and all versions of the E-WARRM (five individual runs and overall) were similar within each listener group, with the younger listeners with normal hearing outperforming the OHL listeners on all measures. Correlation analyses revealed moderate to strong associations between the abbreviated WARRM runs and the O-WARRM for the OHL listener group. Hierarchical regression modeling suggested that run 1 of the E-WARRM was a good predictor of O-WARRM performance and that adding additional runs did not improve the prediction. Taken together, these findings suggest that administering one run from the E-WARRM warrants further examination for clinical use. Additional analyses revealed equivalent scores on all five runs from the three E-WARRM randomizations for both listener groups.

Conclusions:
Abbreviated versions of the O-WARRM were developed as part of this study. This was accomplished by modifying the original presentation paradigm and creating 15 unique “runs” among the original 3 randomizations. The resulting 15 runs could be considered 15 unique and abbreviated WARRM lists that have potential, in the future after further studies are conducted to establish important properties, for clinic use. The abbreviated WARRM lists may be useful for quantifying auditory working memory of listeners with hearing loss during the audiologic rehabilitation process.
Comparison of Pure-Tone Thresholds and Cochlear Microphonics Thresholds in Pediatric Cochlear Implant Patients
Authors: Coulthurst Sarah , Nachman Alison J. , Murray Mike T. , Koka Kanthaiah , Saoji Aniket A. 
Published: April 2020

Objectives:
In adult cochlear implant patients, conventional audiometry is used to measure postoperative residual hearing which requires active listening and patient feedback. However, audiological measurements in pediatric cochlear implant patients are both challenging as well as time consuming. Intracochlear electrocochleography (ECOG) offers an objective and a time-efficient method to measure frequency-specific cochlear microphonic or difference thresholds (CM/DIF) thresholds that closely approximate auditory thresholds in adult cochlear implant patients. The correlation between CM/DIF and behavioral thresholds has not been established in pediatric cochlear implant patients. In the present study, CM/DIF thresholds were compared with audiometric thresholds in pediatric cochlear implant patients with postoperative residual hearing.

Design:
Thirteen (11 unilateral and 2 bilateral) pediatric cochlear implant patients (mean age = 9.2 years ± 5.1) participated in this study. Audiometric thresholds were estimated using conventional, condition play, or visual reinforcement audiometry. A warble tone stimulus was used to measure audiometric thresholds at 125, 250, 500, 1000, and 2000 Hz. ECOG waveforms were elicited using 50-msec acoustic tone-bursts. The most apical intracochlear electrode was used as the recording electrode with an extra-cochlear ground electrode. The ECOG waveforms were analyzed to determine CM/DIF thresholds that were compared with pediatric cochlear implant patients’ audiometric thresholds.

Results:
The results show a significant correlation (r = 0.77, p < 0.01) between audiometric and CM/DIF thresholds over a frequency range of 125 to 2000 Hz in pediatric cochlear implant patients. Frequency-specific comparisons revealed a correlation of 0.82, 0.74, 0.69, 0.41, and 0.32 between the audiometric thresholds and CM/DIF thresholds measured at 125, 250, 500, 1000, and 2000 Hz, respectively. An average difference of 0.4 dB (±14 dB) was measured between the audiometric and CM/DIF thresholds.

Conclusions:
Intracochlear ECOG can be used to measure CM/DIF thresholds in pediatric cochlear implant patients with residual hearing in the implanted ear. The CM/DIF thresholds are similar to the audiometric thresholds at lower test frequencies and offer an objective method to monitor residual hearing in difficult-to-test pediatric cochlear implant patients.