bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contraception, Abortion and More: Understanding Health Disparities for LBGTQ Patients in their Own Words [10G]
Authors: Hoffmann Jennifer , Bergin Ashlee 
Published: October 2020

INTRODUCTION:
Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) women experience numerous obstacles to accessing equitable reproductive healthcare. These barriers lead to known disparities in health outcomes between LGBTQ women and their straight counterparts. Despite these disparities, few published research studies specifically explore the health experiences of LGBTQ women in regards to contraception, abortion and obstetric care. This qualitative, grounded theory study seeks to address that gap.

METHODS:
Purposive sampling was used to recruit English speaking, LGBTQ individuals aged 18- to 45-year-old living in Kentucky. Participants (n = 10) were recruited and in-depth audio recorded interviews were performed. The transcriptions were then uploaded to Atlas.ti and analyzed using the Constant Comparative Method to identify relevant themes.

RESULTS:
Six themes were identified, including: identifying LGBTQ friendly practices, establishing trust and rapport, covert and overt provider bias, provider ignorance of LGBTQ health-specific issues, patient education and counseling, and additional barriers for transgender patients. These themes were sorted into a conceptual paradigm that represents three phases of the health care experience relating to care within the scope of Ob/Gyn: Pre-visit inquiry, direct provider interaction, and post-provider effects.

CONCLUSION:
Participants identified numerous barriers for LGBTQ patients seeking care within an Ob/Gyn practice. These barriers included a uniform difficulty with identifying receptive and adequately trained providers, perceived covert and overt bias, as well as difficulty establishing trust and rapport. Finally, while all LGBTQ women experienced some aspect of bias, the difficulties faced by transgender patients in accessing reproductive health care were notably more challenging.
Vaginal CO2 Laser Versus Topical Estriol Treatment for Vaginal Atrophy in Postmenopausal Women: 1-Year Follow-up [20P]
Authors: Cruz Vera , Wajsfeld Tali , Steiner Marcelo , Pompei Luciano , Fernandes Cesar 
Published: October 2020

INTRODUCTION:
Vulvovaginal atrophy (VVA) affects up to 50% of postmenopausal women with great impact on quality of life and sexual function. Vaginal CO2 laser is a promising therapeutic, but its long-term efficacy is unknown.

METHODS:
45 postmenopausal women were randomized in 3 groups on a double-blind, placebo-controlled study: L group (vaginal fractional CO2 laser), E group (topical Estriol), or LE group (combination of both). Assessments at 12 weeks (week 20) and 1-year after treatment completion were conducted using Vaginal Health Index (VHI), Visual Analog Scale for VVA symptoms (dyspareunia, dryness, and burning), Female Sexual Function Index (FSFI), and maturation value of Meisels.

RESULTS:
Of the 45 women, 6 were lost to follow-up at 1-year. No adverse effects were reported throughout the study. The average VHI score was significantly higher at week 20 in all study arms. VHI scores and symptoms of dyspareunia, dryness and burning were similar at week 20 and 1-year (p=0.59) in the L group. Both estrogen treated groups with and without combined laser had significant lower VHI scores (p=0.02 and p=0.0001, respectively) and worsening symptoms of hydration and burning when compared to week 20. Patient perception of symptoms on FSFI was similar in all study arms at week 20 and 1-year (p=0.5).

CONCLUSION:
Improvement of VVA symptoms persisted 1-year after fractional CO2 treatment. Outcomes of Estriol therapy alone or associated with laser were not maintained 1-year after treatment, although estriol remains a safe treatment option for VVA symptoms.
The Impact of Intrapartum Uterine Rupture on Perinatal Outcomes [21T]
Authors: Yule Casey S. , Happe Sarah K. , McIntire Donald D. , Wells C. Edward 
Published: October 2020

INTRODUCTION:
To describe maternal and neonatal outcomes of pregnancies complicated by uterine rupture at a single institution.

METHODS:
Retrospective review of pregnancies complicated by uterine rupture from 2009-2016. Uterine rupture was defined as a uterine defect involving the entire thickness of the uterine wall. Maternal and neonatal outcomes were analyzed. If cesarean delivery was performed, time was calculated from decision to perform surgery to skin incision. Standard statistical analysis was performed.

RESULTS:
There were 40 cases of uterine rupture with an overall rate of 4.9 ruptures per 10,000 births. The rupture rate did not change over time (P=0.23). Of primary uterine ruptures, 93% received uterine stimulants for labor induction or augmentation. Compared with primary ruptures, secondary ruptures occurred at an earlier gestational age (P<0.001) and were associated with less blood loss (P=0.024). Uterine rupture resulted in the need for transfusion in 55%, hysterectomy in 27%, and maternal admission to the intensive care unit in 17%. Emergent delivery for maternal or fetal indications occurred with a decision to incision time averaging 10 minutes. Catastrophic neonatal outcomes were observed despite decision to incision times averaging 19 minutes for infants with acidemia, 17 minutes for infants with hypoxic ischemic encephalopathy, and 13 minutes for cases resulting in neonatal death.

CONCLUSION:
Uterine rupture is a serious complication for women and their infants undergoing induction or augmentation of labor and for those pursuing a trial of labor after a cesarean delivery. Despite expedient decision to incision times, intrapartum uterine rupture may result in catastrophic perinatal outcomes.
Pregnancies Lost and Found: Improving Follow Up for Patients With Pregnancies of Unknown Location [4R]
Authors: Latteman Lindsey , Hosein Safiyah , Garber Laurel M. , Leung Andrea , Paoletti Andrew , Gurney Elizabeth Price 
Published: October 2020

INTRODUCTION:
Patients with pregnancy of unknown location (PUL) are followed with serial beta human chorionic gonadotropin (bhCG) levels until definitive diagnosis. Historically, our institution's OB/GYN residents maintained an ad hoc database of PUL patients, separate from the electronic medical record (EMR) and patients had poor follow up compliance. We hypothesized that by integrating PUL management into the EMR, standardizing follow-up procedures, and providing consistent faculty oversight, we could increase patient compliance with follow-up.

METHODS:
Changes to PUL management were undertaken through a Quality Improvement (QI) project, including: templated EMR notes, standardized patient contact and follow-up algorithms, and twice-weekly faculty supervision. We compared patient compliance with follow-up and EMR documentation pre- and post-QI intervention. 91 subjects were required per group to detect the predicted difference in compliance of 20% to 40%.

RESULTS:
177 records were reviewed (92 pre-QI; 86 post-QI). Demographics and admitting diagnoses were similar between groups. Post-QI more patients with PUL completed follow up (67.4% vs. 53.2%, p=0.047); more patients had EMR documentation of any follow up (100% vs.70.7%, p<0.001) and of a final diagnosis (90.7% vs. 31.5%, p<0.001); more patients were contacted at standard intervals (PUL, 86.7% vs. 53.7%, p<0.001; ectopic, 100% vs. 72.7%, p=0.006). However, despite regular faculty supervision, EMR documentation of attending oversight was unchanged (47.7% vs. 39.1%, p=0.32).

CONCLUSION:
We observed statistically significant improvements in patient compliance with standard follow up, in EMR documentation of care, and in provider adherence to follow up algorithm, as a result of this QI project at our institution.
Application of Opposing Triangle Flaps in Three Different Kinds of Conjoined Twins
Authors: Liu Xiangqi , Li Jun , He Weijing , Zhang Shuai , Dong Chenbin 
Published: October 2020

ABSTRACT

BACKGROUND
Conjoined twins are a rare congenital anomaly. If separation of the conjoined organs is feasible, reconstruction of the skin and tissue defects is a challenge for the plastic surgeon. This article describes the use of opposing triangle flaps in the separation of three different kinds of conjoined twins.

METHODS
Plastic surgeons measured each conjoined area and designated the vertical length as a and the width as b. The length of the base of the opposing triangle flap was calculated to match a, and the height of the triangle to match b.

RESULTS
After detailed calculations and careful surgery, the area of the opposing triangle flaps nearly covered the areas exposed after separation, and the three conjoined twins achieved primary closure of their wounds. The pygopagus and ischiopagus twins recovered uneventfully. The omphalopagus twins developed a wound infection, but after daily wound care, the twins recovered within a week.

CONCLUSIONS
With precise calculations, the opposing triangle flap is a feasible and effective method for defect closure after separation of conjoined twins in certain cases. Clinicians may prefer this technique because it avoids the complications and second surgery necessitated by tissue expanders.
Electric Stimulation as an Effective Adjunctive Therapy for Diabetic Foot Ulcer: A Meta-analysis of Randomized Controlled Trials
Authors: Chen Zong , Chen Zhi-You , Liu Wen-Hui , Li Guang-Shuai 
Published: October 2020

ABSTRACT

OBJECTIVE
To evaluate the effectiveness of electric stimulation (ES) for diabetic foot ulcer (DFU) treatment.

METHODS
The authors searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases for randomized clinical trials published through March 2019 that compared the efficacy of ES and standard wound care (SWC) versus SWC alone for DFU treatment. The outcomes were pooled using a random-effects model.

RESULTS
Of the 145 randomized clinical trials initially identified, seven studies (with a total of 274 patients) met the inclusion criteria. The percentage decrease in ulcer area at 4 weeks was significantly greater in patients treated with ES and SWC than SWC alone (standardized mean difference, 1.09; 95% confidence interval, 0.62-1.57; P < .001). The ulcer healing rate at 12 weeks was also significantly faster in the ES group (risk difference, 0.19; 95% confidence interval, 0.06–0.32; P = .005). Subgroup analysis showed comparable efficacies with different waveforms (monophasic vs biphasic).

CONCLUSIONS
Electrical stimulation appears to be an effective adjunctive therapy for accelerating DFU healing.
Advances in airway management and mechanical ventilation in inhalation injury
Authors: Gigengack Rolf Kristian , Cleffken Berry Igor , Loer Stephan Alexander 
Published: October 2020

Purpose of review
Airway management, mechanical ventilation, and treatment of systemic poisoning in burn patients with inhalation injury remains challenging. This review summarizes new concepts as well as open questions.

Recent findings
Several life-threatening complications, such as airway patency impairment and respiratory insufficiency, can arise in burn patients and require adequate and timely airway management. However, unnecessary endotracheal intubation should be avoided. Direct visual inspection via nasolaryngoscopy can guide appropriate airway management decisions. In cases of lower airway injury, bronchoscopy is recommended to remove casts and estimate the extent of the injury in intubated patients. Several mechanical ventilation strategies have been studied. An interesting modality might be high-frequency percussive ventilation. However, to date, there is no sound evidence that patients with inhalation injury should be ventilated with modes other than those applied to non-burn patients. In all burn patients exposed to enclosed fire, carbon monoxide as well as cyanide poisoning should be suspected. Carbon monoxide poisoning should be treated with an inspiratory oxygen fraction of 100%, whereas cyanide poisoning should be treated with hydroxocobalamin.

Summary
Burn patients need specialized care that requires specific knowledge about airway management, mechanical ventilation, and carbon monoxide and cyanide poisoning.
Buprenorphine/Naloxone for Opioid Use Disorder Among Alaska Native and American Indian People
Authors: Lillie Kate M. , Shaw Jennifer , Jansen Kelley J. , Garrison Michelle M. 
Published: October 2020

Objectives:
Opioid-related disparities are magnified among Alaska Native and American Indian (ANAI) people. Yet, no outcome studies on medication for addiction treatment, an effective treatment in other populations, among ANAI people exist. The objective of this study was to identify variables associated with buprenorphine/naloxone retention among ANAI people with opioid use disorder (OUD).

Methods:
The sample was 240 ANAI adults in Anchorage, Alaska who received buprenorphine/naloxone treatment for an OUD. We gathered data from the electronic health record from January 1, 2015 to December 31, 2019. We used survival analysis to explore possible predictors (demographic variables, psychiatric comorbidity, medical severity, previous opioid prescriptions, previous injury, alcohol use disorder, and co-occurring substance use) of length of treatment retention (in days) while accounting for right censoring.

Results:
We found that 63% of the 240 patients were retained in buprenorphine/naloxone treatment at 90 days, 51% at 6 months, and 40% at 1 year, slightly lower than the general US population. Younger age (hazard ratio 1.69, 95% confidence intervals 1.17–2.45) and co-occurring substance use (hazard ratio 2.95, 95% confidence intervals 1.99–4.38) were associated with increased rate of buprenorphine/naloxone treatment discontinuation.

Conclusions:
Younger patients and those with co-occurring substance use remain at higher risk of discontinuing buprenorphine/naloxone treatment for OUD in this population of ANAI people. Treatment programs serving ANAI people may consider paying special attention to patients with these characteristics to prevent treatment discontinuation. Our study highlights the need to address poly-substance use among ANAI people in treatment.
Can Individuals With Alcohol Use Disorder Sustain Non-abstinent Recovery? Non-abstinent Outcomes 10 Years After Alcohol Use Disorder Treatment
Authors: Witkiewitz Katie , Wilson Adam D. , Roos Corey R. , Swan Julia E. , Votaw Victoria R. , Stein Elena R. , Pearson Matthew R. , Edwards Karlyn A. , Tonigan Jeffrey Scott , Hallgren Kevin A. , Montes Kevin S. , Maisto Stephen A. , Tucker Jalie A. 
Published: October 2020

Objective:
Four decades ago, the “controlled drinking” controversy roiled the alcohol field. Data have subsequently accumulated indicating that nonabstinent alcohol use disorder (AUD) recovery is achievable, but questions remain whether it is sustainable long-term. This study examined whether nonabstinent recovery at 3 years after AUD treatment is associated with better functioning at 10 years after treatment.

Methods:
Data were from the 10-year follow-up of Project MATCH (New Mexico site only, n
= 146; 30.1% female, 58.6% non-White). Recovery was defined by latent profile analyses based on psychosocial functioning and alcohol consumption 3 years after treatment. Drinking practices and consequences, depression, purpose in life, and anger were assessed 10 years after treatment. Distal outcome analyses examined differences in drinking and functional outcomes at 10 years as a function of the 3-year latent profiles. Analyses were preregistered at https://osf.io/3hbxr.

Results:
Four latent profiles identified at 3 years after treatment (ie, low functioning frequent heavy drinkers, low functioning infrequent heavy drinkers, high functioning heavy drinkers, and high functioning infrequent nonheavy drinkers) were significantly associated with outcomes 10 years after treatment. The 2 high functioning profiles at 3 years had the highest level of psychological functioning at 10 years posttreatment, regardless of alcohol consumption level. Abstinence at 3 years did not predict better psychological functioning at 10 years.

Conclusions:
Nonabstinent AUD recovery is possible and is sustainable for up to 10 years after treatment. The current findings align with recent proposals to move beyond relying on alcohol consumption as a central defining feature of AUD recovery.
Mortality Predictors in Elderly Patients With Cardiogenic Shock on Venoarterial Extracorporeal Life Support. Analysis From the Extracorporeal Life Support Organization Registry*
Authors: Kowalewski Mariusz , Zieliński Kamil , Maria Raffa Giuseppe , Meani Paolo , Lo Coco Valeria , Jiritano Federica , Fina Dario , Matteucci Matteo , Chiarini Giovanni , Willers Anne , Simons Jorik , Suwalski Piotr , Gaudino Mario , Di Mauro Michele , Maessen Jos , Lorusso Roberto 
Published: October 2020

OBJECTIVES:
Because significantly higher mortality is observed in elderly patients undergoing venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock, decision-making in this setting is challenging. We aimed to elucidate predictors of unfavorable outcomes in these elderly (≥ 70 yr) patients.

DESIGN:
Analysis of international worldwide extracorporeal life support organization registry.

SETTING:
Refractory cardiogenic shock due to various etiologies (cardiac arrest excluded).

PATIENTS:
Elderly patients (≥ 70 yr).

INTERVENTIONS:
Venoarterial extracorporeal membrane oxygenation.

MEASUREMENTS AND MAIN RESULTS:
Three age groups (70–74, 75–79, ≥80 yr) were in-depth analyzed. Uni- and multivariable analysis were performed. From January 1997 to December 2018, 2,644 patients greater than or equal to 70 years (1,395 [52.8%] 70–74 yr old, 858 [32.5%] 75–79 yr, and 391 [14.8%] ≥ 80 yr old) were submitted to venoarterial extracorporeal membrane oxygenation for refractory cardiogenic shock with marked increase in the most recent years. Peripheral access was applied in majority of patients. Median extracorporeal membrane oxygenation support duration was 3.5 days (interquartile range: 1.6–6.1 d), (3.9 d [3.7–4.6 d] in patients ≥ 80 yr) (p < 0.001). Weaning from extracorporeal membrane oxygenation was possible in 1,236 patients (46.7%). Overall in-hospital mortality was estimated at 68.3% with highest crude mortality rates observed in 75–79 years old subgroup (70.1%). Complications were mostly cardiovascular and bleeding, without apparent differences between subgroups. Airway pressures, 24-hour pH after extracorporeal membrane oxygenation start, extracorporeal membrane oxygenation duration, and renal replacement therapy were predictive of higher mortality. In-hospital mortality was lower in heart transplantation recipients, posttranscatheter aortic valve replacement, and pulmonary embolism; conversely, higher mortality followed extracorporeal membrane oxygenation institution after coronary artery bypass + valve and in decompensated chronic heart failure, and nearly 100% mortality followed in extracorporeal membrane oxygenation for sepsis.

CONCLUSIONS:
This study confirmed the remarkable increase of venoarterial extracorporeal membrane oxygenation use in elderly affected by refractory cardiogenic shock. Despite in-hospital mortality remains high, venoarterial extracorporeal membrane oxygenation should still be considered in such setting even in elderly patients, since increasing age itself was not linked to increased mortality, whereas several predictors may guide indication and management.
Automated blood pressure measurement in atrial fibrillation: validation process modification and evaluation of a novel professional device which detects atrial fibrillation and adapts its blood pressure measurement algorithm
Authors: Stergiou George S. , Kyriakoulis Konstantinos G. , Bountzona Ioanna , Menti Ariadni , Destounis Antonios , Kalogeropoulos Petros , Kollias Anastasios 
Published: October 2020

Objectives:
Blood pressure (BP) measurement in atrial fibrillation (AF) patients is problematic and automated monitors are regarded as inaccurate. The optimal procedure for validating BP monitors in AF is questionable. This study evaluated the accuracy of a novel professional oscillometric upper-arm cuff device (Microlife WatchBP Office), which has an algorithm for detecting AF and then applies an AF-specific BP measurement algorithm. BP variability, which is inherently increased in AF patients, was considered in the analysis.

Methods:
Subjects with sustained AF were included in a validation study using the same arm sequential measurement method of the Universal Standard (ISO 81060-2:2018) for special populations. Analysis was performed in all subjects and separately in those with and without high reference BP variability (>12/8 mmHg SBP/DBP).

Results:
Thirty-five subjects with 105 paired test/reference BP measurements were included (mean age 76.3 ± 8.4 years, reference SBP/DBP 128.2 ± 19.5/72.5 ± 12.1 mmHg, pulse rate 68.3 ± 14.9 bpm). Validation Criterion 1 (mean difference ± SD) was 0.0 ± 7.7/0.2 ± 7.0 mmHg in all 105 BP pairs (threshold ≤5 ± 8 mmHg). Criterion 1 was 0.5 ± 6.1/−0.2 ± 6.8 mmHg in 18 subjects (54 BP pairs) with low reference BP variability and −0.6 ± 9.2/0.6 ± 7.3 mmHg in 17 (51 pairs) with high variability. Criterion 1 did not differ in pulse rate < 70 vs. ≥ 70 bpm Validation Criterion 2 (SD of differences for 35 individuals) was 5.38/6.20 mmHg (SBP/DBP; threshold ≤6.95/6.95).

Conclusion:
A technology which detects AF and activates an AF-specific BP measurement algorithm introduces a challenging solution for clinical practice. Validation of BP monitors in AF patients should not ignore their inherently high BP variability.
The Efficacy of Atropine Combined With Orthokeratology in Slowing Axial Elongation of Myopia Children: A Meta-Analysis
Authors: Gao Canran , Wan Shuling , Zhang Yuting , Han Jing 
Published: October 2020

Objectives:
Previous studies have found that atropine can slow axial elongation and control the progression of myopia. Some ongoing trials have applied atropine combined with orthokeratology for myopia control, but few studies explored the effect of the strategy on axial elongation. This meta-analysis made a preliminary evaluation of the effect of atropine combined with orthokeratology on axial elongation to provide a reference for further researches.

Methods:
We performed a specific search on PubMed, EMBASE, Cochrane library, Web of Science, Ovid and Chinese electronic databases of VIP and Wanfang for randomized controlled trials, cohort studies and case-control studies conducted up to December 2019. The weighted mean difference (WMD) of mean change in axial elongation between the combination group of atropine and orthokeratology and the orthokeratology group was used for evaluation. Publication bias was detected using the Funnel plots test.

Results:
A total of five studies involving 341 participants younger than 18 years old met our inclusion criteria. The axial elongation was lower in the combination group of atropine and orthokeratology than that of the orthokeratology group (0.25 vs. 0.35; WMD=−0.09 mm, [95% confidence intervals, −0.15 to −0.04], Z=3.39, P=0.0007).

Conclusions:
This meta-analysis demonstrates atropine combined with orthokeratology is effective in slowing axial elongation in myopia children. This effect may be superior to that of the orthokeratology alone.