bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical-Legal Partnerships: Supporting the Legal Needs of Women in Their Perinatal Care [16F]
Authors: Gutierrez Griselda , Saleeby Erin , Celaya Anna , Clouse Julia , Hoffman Catherine , Kornberg Jessie 
Published: April 2020

INTRODUCTION:
Medical-legal partnership (MLP) aims to address the numerous social determinants of health. In July 2018 we added an MLP service for pregnant and postpartum women in an underserved safety net hospital in Los Angeles County. Here, we examine the prevalence of legal needs ascertained by self-administered legal needs assessments and the conversion rate of referrals to legal cases.

METHODS:
The MLP service was implemented as part of the continuum of clinical care. Referrals are tracked as part of case management. Review of self-administered screenings provided our referral screen-positive rates. Of those clients referred, a case conversion rate was calculated when legal cases were generated.

RESULTS:
Legal needs were identified in the following areas: family law (27%), employment (25%), housing (11%), and immigration (11%). A 72% screen positive rate (79 of 110) was found when clinic staff (provider, nursing, or social worker) directly referred to the MLP. Legal advice was often provided to those who screened positive (64%). Conversion rates were also high with 58% of those referred for formal legal action resulting in open cases (46 of 79 referred).

CONCLUSION:
Legal needs, such as assistance with employment law for pregnancy related disability accommodations, may have direct impacts on perinatal outcomes. Incorporating the MLP in resource-limited clinical settings can be achieved by including stakeholders in its development. The high conversion rate of referrals to cases illustrates the ability of the medical staff and patients to effectively identify legal needs and then partner with legal aid groups to address these concerns.
Patient and Provider Perspectives on Managing Pain With Opioids After Cesarean Delivery or Hysterectomy [18F]
Authors: Shi Carol , Risica Patricia M. , Danilack Valery A. , Sunday Joyce , Collins Erica , Matteson Kristen A. 
Published: April 2020

INTRODUCTION:
Despite the prevalence of opioid prescribing after Cesarean delivery (CD) and hysterectomy in the United States, little is known about patients’ concerns regarding pain management and physicians’ attitudes regarding opioid prescribing practices. We conducted focus groups to characterize patient and provider perspectives on prescription opioid utilization, storage, and disposal.

METHODS:
We recruited women who had a recent CD or hysterectomy and physicians who perform CD and/or hysterectomy. Focus group discussions covered barriers to individualized opioid prescriptions, content of pain management conversations, and preferences for educational materials for safe opioid utilization, storage, and disposal. Approval was obtained from Women & Infants' Institutional Review Board.

RESULTS:
We conducted a total of 6 focus group sessions: 2 CD (n=21), 2 hysterectomy (n=18), and 2 with physicians who perform CDs and/or hysterectomies (n=12). Patient experiences with postoperative pain management were highly varied. While some avoided opioids despite maximum doses prescribed, others described concerns such as fear of pain that motivated them to consume more opioids. Patients reported that physicians often did not consult them about medication preferences or pain control expectations. Physicians were unsure how other members of the medical team counseled patients about opioid utilization and were unaware of best practices for safe opioid disposal. Patients’ concerns regarding pain management with opioids often coincided with absent, inconsistent, or unclear counseling from providers.

CONCLUSION:
Optimizing physician-patient discussions of pain expectations, individualized opioid prescribing, and education about safe opioid storage and disposal throughout the perioperative period may improve patient experiences and adherence to best practices for opioid utilization.
Reproductive Healthcare Provision in the Veterans Healthcare Administration: A Mixed Methods Evaluation [20F]
Authors: Gawron Lori M. , Callegari Lisa S. , Galyean Patrick , Young Jeanette , Yang Serena , Zickmund Susan L. 
Published: April 2020

INTRODUCTION:
Despite efforts to prioritize comprehensive care for women Veterans within the Veterans Health Administration (VHA), disparities in reproductive health services exist, especially for those accessing care in rural VHA community-based outpatient clinics (CBOCs). We sought to understand barriers and facilitators to VHA reproductive health service provision, including in rural settings.

METHODS:
We performed a mixed methods study, including a quantitative survey and semi-structured, qualitative interviews. We recruited women’s health primary care providers and support staff from the Salt Lake City medical center and 8 surrounding CBOCs. We employed a Likert scale to assess comfort with 17 reproductive health services and performed descriptive analyses. In qualitative interviews, we explored provider/staff training, current care processes, and improvement opportunities. We audio-recorded, transcribed, and used Crabtree and Mill’s Editing Approach to identify dominant themes.

RESULTS:
We recruited 15 participants across 9 sites (4 physicians, 7 nurse practitioners and 4 registered nurses). Mean age was 49.6 years, 86.7% were women, and 93.3% were white. Comfort scores were lowest for fertility counseling and intrauterine device or implant management. In qualitative analyses, barriers included inability to attain/maintain proficiency, staff turnover, inability to order or maintain supplies, referral challenges, and lack of Veteran awareness of available services. We identified few facilitators, including reproductive health experience outside the VHA, invested support staff, and care coordination relationships at the VHA medical center or in the community.

CONCLUSION:
Addressing barriers to VHA reproductive healthcare provision is needed to overcome disparities related to clinic location and to improve reproductive health outcomes for all women Veterans.
Use and Utility of Endocervical Curettage at Colposcopy [21F]
Authors: Guan Yue , Class Quetzal A. , Litwiller Abigail 
Published: April 2020

INTRODUCTION:
Few studies have investigated the diagnostic utility of endocervical curettage (ECC) since the 2013 ASCCP Updated Consensus Guidelines. We evaluate the use of ECC at colposcopy for detection of ≥ cervical intraepithelial neoplasia (CIN) two.

METHODS:
IRB approved retrospective chart review included patients attending colposcopy clinic at a large urban hospital from January 2017 to January 2019 (N=402). From electronic medical records we extracted demographic characteristics, medical comorbidities, insurance status, pap smear cytology, HPV results, and colposcopy results including biopsy or ECC pathology. We used Chi-square to evaluate the use and diagnostic utility of ECC at time of colposcopy for detection of ≥ CIN two.

RESULTS:
An ECC was performed in 66.9% of colposcopies and 7.8% of those returned with pathology of ≥ CIN two. Transplant recipients were significantly more likely to have an ECC performed during colposcopy (X2(1, N=402)=7.23, P<.05) while ECC was less frequent for those with unsatisfactory pap cytology (70% did not receive ECC, P<.001). Inadequate colposcopy was associated with a higher likelihood of receiving ECC (P<.0001). ECCs were significantly more likely to be performed when cervical biopsy was also performed (74% vs 58% with no biopsy; X2(2, N=402, P<.05). Cervical biopsy CIN results agreed with ECC CIN results (X2(1, N=151)=20.62, P<.0001). In 4.2% of colposcopies, when cervical biopsy revealed no dysplasia or CIN 1, ECC revealed ≥ CIN 2.

CONCLUSION:
ECCs were performed more frequently in transplant patients, inadequate colposcopy, and when cervical biopsy was also obtained. In most cases ECC did not change management.
Reproductive Healthcare Experiences of Incarcerated Women: A Qualitative Study [30F]
Authors: O'Connor Sarah , Perkins Rebecca 
Published: April 2020

INTRODUCTION:
The U.S. prison population has reached an all-time high, with women representing the fastest growing sub-population. Recently, national medical organizations recognized inadequate correctional health care as a major problem. Despite this awareness, the U.S. correctional health care system remains fragmented and non-uniform in practice, particularly in women’s healthcare, with poor transitions between incarceration and the community. The purpose of this study was to examine how formerly incarcerated women navigate this system to address their reproductive healthcare needs.

METHODS:
Adult, English-speaking women with history of incarceration within the last 10 years were interviewed using a semi-structured interview tool. Interviews were analyzed using modified grounded theory and stopped upon thematic saturation. Interview themes were used to create a conceptual framework to describe this fragmentation.

RESULTS:
21 women completed the study interview. They were on average 43 years old, with 7 periods of incarceration. 80% had children, and 52% were pregnant while incarcerated. Most women described fragmentation of care with inability to consistently access reproductive and prenatal healthcare services. Frequent transitions between institutions exacerbated problems with access. A high prevalence of mental health issues, including high rates of substance use disorder contributed to difficulty accessing needed services. Women suggested better coordination of care could improve their long-term health.

CONCLUSION:
This study illuminates the persistent reproductive health barriers that face formerly incarcerated women. Programs are needed to address the physical and mental health needs for women transitioning from incarceration back into the community.
Seroprevalence of HPV Infections in the Cervix and Penis in Unvaccinated Individuals: A Study of 3,143 Participants [31F]
Authors: Abel Mary Kathryn , Mann Amandeep , Kapp Daniel , Chan John 
Published: April 2020

INTRODUCTION:
To determine the seroprevalence of cervical and penile HPV infections in unvaccinated, sexually-active adults in the United States.

METHODS:
Data were obtained from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016. HPV serotypes were determined by cervicovaginal swabs in females and penile specimens in males. Chi-square was used for statistical analysis.

RESULTS:
Of 3,143 unvaccinated, sexually-active adults (median age: 28 years), 2,608 (83%) were female and 535 (17%) were male. Median lifetime sexual partners was 5 for women and 6 for men. 59.1% of females and 45.8% of males were infected with HPV. For unvaccinated women, of the top five HPV serotypes, only HPV 16 and 51 were considered high-risk and comprised 6.81% and 5.45%, respectively. The additional serotypes included HPV 53 (6.9%), 89 (6.0%), and 84 (5.7%). Of the top five HPV serotypes in unvaccinated men, HPV 51 and 66 were considered high-risk and comprised 7.2% and 5.8% of all infections; the remaining serotypes included HPV 62 (7.3%), 53 (5.5%), and 89 (5.4%). Infection with HPV serotypes covered by the 9-valent vaccine represented 21.8% of infections in females and 22.1% of infections in males in this study cohort (P=.96).

CONCLUSION:
In unvaccinated individuals, both men and women are at risk for infection for cancer-associated HPV types with varying seroprevalence. The efficacy of the 9-valent vaccination may have varying efficacy depending on gender and site of infection.
Cuff Dehiscence in Endometrial Cancer Patients After Robotic Laparoscopic Total Hysterectomy [35F]
Authors: Griggs Paige , Duong Jennifer , Okut Hayrettin , Morgan Jacqueline , Kolojeski Maria , Miller Kevin 
Published: April 2020

INTRODUCTION:
Cuff dehiscence (CD) is a serious complication of robotic-assisted laparoscopic total hysterectomy (RLTH), which is performed for malignant or benign indications. The primary objective of this study was to evaluate if there is a difference in incidence and risk factors of CD following RLTH among patients with endometrial cancer compared to patients without endometrial cancer.

METHODS:
This retrospective study included women 18 years or older who underwent RLTH performed by one of two surgeons from a single institution from January 1, 2013 through March 31, 2018. Conversion to open laparotomy, chemotherapy/radiation within a year before or after RLTH, and malignancies other than endometrial cancer were excluded. Data were abstracted from patient medical records. This study received IRB approval.

RESULTS:
Of 950 patients meeting inclusion criteria, 50.7% (n=482) had endometrial cancer. CD was reported in 2.5% (n=24) of all patients. While holding other variables constant, obese patients were 25.1% less likely than normal weight patients to experience CD, χ2(1, N=675)=6.49, P=.011. Additionally, CD was 2.8 times more likely to occur when surgery was performed by surgeon 1 compared to surgeon 2 while other variables in the model were held constant, χ2(1, N=675)=4.87, P=.027. No other variables (cancer status, age, sexual activity after surgery, distance from home to location of surgery, time interval from surgery to loss to follow-up) predicted CD.

CONCLUSION:
Endometrial cancer patients were at no greater risk of experiencing CD compared to non-cancer patients. This study suggests that BMI and surgical technique are the only variables associated with incidence of CD.
Predicting Surgical Failure of Midurethral Sling Placement: The Value of Preoperative Pelvic Floor Strength [38F]
Authors: Timmons Douglas B. , Grady Mary , Ibrahim Catrine , Garcia Alexandra , Garcia Mercedes , Medina Carlos 
Published: April 2020

INTRODUCTION:
Pelvic floor muscle training is the first line nonsurgical intervention for urinary incontinence. Midurethral sling placement is the first line surgical intervention. Our objective was to evaluate the impact of pelvic floor muscle strength on success of surgical intervention.

METHODS:
A retrospective chart review was performed of all patients whom underwent an isolated RPMUS for either USI or MUI. Patients were divided into two groups based on PFMS determine pre-operatively utilizing a Modified Oxford Scale (0-5). Group 1-W (W=weak, PFMS=MOS ≤ 2) and group 2-S (S=strong, PFMS=MOS>2. Failure was defined as any patient reporting SUI or urge urinary incontinence (UUI) on the first postoperative visit. P-value<0.05 was considered significant.

RESULTS:
64 patients met inclusion criteria and each group was composed of 32 each (group 1-W, n=32 and group 2-S, n=32). Weaker or stronger pelvic floor muscle strength did not make a significant difference in the overall continence outcome among patients with preoperative SUI and or SUI and urgency only. However, in patients with MUI there was significantly more recurrence (USI/UUI) in the weaker PFMS (group 1-W) compared to the stronger PFMS (group 2-S), Table 2.

CONCLUSION:
Our results indicate that patients with MUI are at greater risk for failure if the PFMS is weaker compared to if stronger. Patients with weak PFMS and MUI should be counselled regarding the higher risk for failure. More importantly this study reinforces the value of strengthening the pelvic floor muscles prior to undergoing surgery, specifically in patients with MUI.
Understanding Women's Treatment Preferences for Pelvic Floor Disorders [40F]
Authors: Spiers Alaina , Vardeman Jennifer , Antosh Danielle 
Published: April 2020

INTRODUCTION:
One in four women 20-years and older have at least one pelvic floor disorder (PFD). Studies show there is a lack of awareness and incorrect perception of PFDs among women of all ages. These factors may affect how women treat PFDs. Therefore, this study assessed women of different ages and risk levels knowledge, attitudes, and behaviors around PFDs to understand treatment decisions.

METHODS:
Researchers sought and gained informed consent from women of varying ages, ethnicities, and risk levels to participate in qualitative one-on-one interviews (n=20) and a focus group (n=6). After data collection, the participants' data were split into four groups for thematic analysis: women under 50 without PFD (n=12), women under 50 with PFD (n=3), women 50 or over without PFD (n=2), and women 50 or over with PFD (n=9).

RESULTS:
Age and risk level were not variables in participants’ treatment decisions. The majority of participants were not aware PFDs are a medical issue; they were more likely to say that they wouldn’t seek treatment from physicians, instead saying they would just wear pads or do Kegels. Once participants were made aware of PFDs being a legitimate medical issue, factors like time, income, convenience/ease of use, and perceived efficacy were cited as prefaces to treatment. Generally, noninvasive measures were the first choice of women of each category. Four out of five women who had a PFD-related surgery regretted it.

CONCLUSION:
Women of all categories need to be better informed of PFDs by their gynecologists in order to make more informed treatment decisions.
Are Obstetrics and Gynecology Residents Equipped to Care for Transgender Patients? A National Survey Study [04G]
Authors: Qin Lei , Estevez Samantha , Radcliffe Ella , Rabin Jill M. , Rosenthal David 
Published: April 2020

INTRODUCTION:
Obstetricians and gynecologists (OB-GYNs) play an important role in the medical and surgical management of transgender and gender nonconforming (TGNC) patients. Our study aims to assess three self-reported outcomes: (1) comfort, (2) competency, and (3) curricular satisfaction of OB-GYN residents in TGNC care topics.

METHODS:
Our survey tool consisted of thirty questions on a 4-point Likert scale and was distributed electronically by program coordinators. The survey tool was deemed exempt by the Northwell Health Institutional Review Board. Descriptive statistics and Kruskal-Wallis test by ranks were performed using SPSS 26.0.

RESULTS:
One-hundred and six surveys were completed by OB-GYN residents (response rate=12.0%). Composite mean scores were calculated in the three self-reported outcome domains: comfort (2.8±0.7), competency (2.7±0.6), and satisfaction (2.4±0.7). No statistically significant difference in comfort, competency, and satisfaction scores between residency training level was observed. Male residents were more likely (χ2(1)=5.285, P=.022) to have higher self-reported competency scores than female residents (3.0±0.7 versus 2.5±0.6, respectively). LGBTQ residents were more likely (χ2(1)=5.509, P=.019) to have higher self-reported comfort scores than those who identified as heterosexual (3.1±0.6 versus 2.7±0.7, respectively).

CONCLUSION:
To our knowledge, this is the first study to assess the comfort, competency, and satisfaction of OB-GYN residents in TGNC care topics. Residents reported being more competent and comfortable than satisfied, which suggests that further curricular and clinical exposure is necessary to address the unique healthcare needs of this underserved patient population and to meet the educational needs of residents. LGBTQ residents may be able to share knowledge with peers to increase heterosexual residents’ comfort.
Assessment of Human Trafficking Knowledge Among Staff in a Tertiary Care Academic Medical Center [05G]
Authors: Engler Lauren A. , Mercer Laura 
Published: April 2020

INTRODUCTION:
Millions of men, women, and children are trafficked around the world every year, a number that continues to increase annually. Victims of human trafficking frequently interact with the healthcare system, yet often go unnoticed. Healthcare practitioners hold an important role in recognizing, caring for, and referring victims of trafficking. This study aimed to assess the baseline level of knowledge related to human trafficking amongst staff at a large university hospital.

METHODS:
A previously validated survey was distributed to all employees at Banner University Medical Center using an online module format. A gift card raffle was utilized as incentive to participate. The study was IRB approved.

RESULTS:
There were a total of 2,042 survey responses. Respondents were stratified into groups based on role, specialty, and primary practice setting. A total of 81% have never received human trafficking training. Those who indicated prior training demonstrated a higher level of knowledge of human trafficking-related questions, and also felt more confident identifying and treating victims of trafficking. All groups of respondents indicated that the preferred method of additional training be pre-recorded online modules.

CONCLUSION:
These results support the need for targeted training related to human trafficking. This will allow a thoughtful and targeted approach to education and resource sharing within and among hospital staff. Moreover, the results indicate that additional training allows staff to feel more equipped to identify and intervene when interacting with victims of human trafficking.
Changing the Narrative; Peer Based Training on Reproductive Health: A Six Year Experience [08G]
Authors: Heger Julie , Shah Nayna , Maguire Karla , Chitters Celeste 
Published: April 2020

INTRODUCTION:
Despite the American College of Obstetricians & Gynecologists recommendations, many medical students are not taught to counsel patients on their reproductive health options. Since 2013, medical students at the University of Miami, under faculty guidance, implemented a curriculum for volunteers who wish to help women in South Florida access long-acting reversible contraception and abortion services.

METHODS:
Students in their third- and fourth-year designed a training program. Second-year students who had undergone the training and had at least one year of experience as a Reproductive Health Advocate (RHA) led the program. The learning objectives were to train new RHAs in contraception, pregnancy termination, patient counseling, laws and finances. Pre- and post-training surveys assessed knowledge, attitudes, and barriers regarding reproductive health.

RESULTS:
Over the past six years, eighty-seven students with an average age of 24 years completed pre-training and post-training surveys. The cohort includes five males, eighty females and two declined to identify gender. Reproductive health knowledge scores improved with a pre-training average score of 58.6% and a post-training score of 83.2%, P<.008. Attitudes towards abortion also changed. Before training, 53% of students “strongly agreed” that abortion is safe; after training 86% “strongly agreed.” Prior to training, only 41% of the students strongly agreed that “abortion access is a problem in the hospital I train.” Post-training assessments showed that 63% of students strongly agreed.

CONCLUSION:
Student-run training improved medical students' understanding of reproductive health and barriers accessing care. To determine generalizability, future studies should replicate this training at different institutions.