bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ethical Issues Identified by Third Year OB-GYN Medical Students Vary According to Rotational Site
Authors: Petrie Kelsey , Adams Allyson , Glover Jacqueline , Guiahi Maryam 
Published: October 2019

PURPOSE:
To categorize ethical concerns identified by OB-GYN medical students and compare across rotational sites.

BACKGROUND:
APGO recognizes that students should understand the basis of ethical issues in OB-GYN in order to promote quality patient care and patient safety. Little, however, is known about how OB-GYN medical students experience ethical issues and if rotational site plays a role. At the University of Colorado School of Medicine, third year OB-GYN students complete an ethics assignment based on their experience rotating at either a university hospital (UH), a safety-net hospital (SH), or a Catholic hospital (CH).

METHODS:
All ethics assignments completed during the 2016-2018 academic years were deidentified of student names and rotational sites. Two investigators independently performed thematic analysis using a previously published OB-GYN ethics framework to categorize assignments and reached consensus. We performed descriptive frequencies and compared ethical categorizations across sites using Pearson’s chi-square.

RESULTS:
252 assignments were analyzed (46.0% UH, 29.8% SH, 24.2% CH). The most common ethical category identified was treatment decisions (80.2%). UH students were more likely to encounter code status (p=0.03), surrogate decision-maker (p=0.03), and fetal viability (p=0.03) issues. SH students were more likely to encounter disagreement in treatment plans between patients and providers (p=0.03) and consent issues (p=0.02). CH students were more likely to encounter issues of institutional policy restricting care (p<0.001) and competing responsibilities of mother versus fetus (p=0.02).

DISCUSSION:
OB-GYN medical students encounter ethical concerns that vary by rotation site. Our findings can inform site-specific educational interventions to address ethical concerns encountered during OB-GYN rotations.
Join the Club: Integration of the CREOG Journal Club Curriculum Improves OBGYN Residents Statistical Literacy
Authors: Wegleitner Elizabeth , Chirino Octavio 
Published: October 2019

PURPOSE:
To evaluate the impact on resident comprehension of biostatistics and research methodology after restructuring a residency journal club based on the CREOG journal club curriculum.

BACKGROUND:
Studies reveal dismal resident performance on statistical literacy evaluations. However, little is known regarding OBGYN residents’ ability to interpret research methodology and results and how these abilities are impacted by the integration of evidence-based medicine principles into journal club curricula.

METHODS:
A pre-/post-intervention study of 22 OBGYN residents at a single institution was conducted to evaluate the impact of integrating the new curriculum (intervention). Participants were administered a survey comprised of 3 sections: a questionnaire in which residents ranked their perceived ability to analyze research literature, a previously validated fifteen question epidemiological/biostatistical knowledge tool, and five questions assessing the curriculum changes. Analysis was performed using Chi-square test, Wilcoxon rank sum test, and paired t-test.

RESULTS:
The overall mean percentage correct on statistical knowledge and interpretation of results pre-intervention was 36.6% versus 67.3% (p<0.0001) post-intervention. Higher pre-intervention scores were associated with prior biostatistics training (45.2% vs 32.9%; p=.001); however, post-intervention, scores were equivalent (66.9% vs 69.4%; p=0.753). Residents (90.9%) preferred the restructured journal club, and 19/22 (86.3%) residents report their desire to continue participating in this journal club format post-training.

DISCUSSION:
Significant improvement in residents’ biostatistics knowledge, with resultant increased confidence in their ability to interpret clinical research results, was a demonstrated outcome of the implementation of the CREOG journal club format. Residency programs can provide more effective biostatistics training by incorporating this curriculum.
Residents Express Emotional, Social and Physical Stress in the Clinical Learning Environment
Authors: Mahany Erica , Dow Margaret , Winkel Abigail , Palmer James , Morgan Helen , Woodland Mark 
Published: October 2019

PURPOSE:
To evaluate OBGYN residents’ perceptions of personal wellness in relation to their clinical learning environment

BACKGROUND:
Resident wellbeing is a significant issue affecting our future physicians’ abilities to fulfill their training potential.

METHODS:
The Council on Resident Education in Obstetrics and Gynecology (CREOG) administered a voluntary, anonymous, six-item wellness survey. One question asked about personal experience with mental health problems (burnout, depression, binge drinking, eating disorders or suicide attempt) and then provided a free text response for “other” issues. The free text responses were reviewed and analyzed. The ACOG IRB determined this survey exempt from review.

RESULTS:
Of 5,061 residents, 4,099 completed the question on personal issues experienced in residency (81% RR), and 200 free text responses were submitted. 1593 residents (32%) endorsed clinical depression. 34 (0.8%) wrote in anxiety, although this was not a formal category. The free text responses clustered into three categories: physical health (n=56), social concerns (n=34), and mood symptoms (n=115). Symptoms of clinical depression comprised 5,992 responses, combining structured questions and free text responses. 18 (0.4%) had attempted suicide, and 18 additional residents wrote in suicide ideation or attempt, translating into almost 1% of our residents having contemplated or tried self-harm, likely related to work stress.

DISCUSSION:
Significant mood disorders and self-harm are under-recognized among OBGYN residents, even as they acknowledge these symptoms. Programs must consider formal evaluations for depression, anxiety, and suicide risk, conduct thorough culture evaluations to ensure these symptoms are not being normalized, and tailor their interventions to provide accessible, confidential support services within the clinical learning environment.
Use of POEs (Point of EPA Evaluations) Across All Third Year Clerkships for Year Long EPA (Entrustable Professional Activity) Monitoring
Authors: Anbazhagan Aruna , Bynum Blythe , Santen Sally , Browning Joel , Dubinsky Brieanne , Rigby Fidelma 
Published: October 2019

PURPOSE:
To describe the development of a school wide and longitudinal assessment of the core Entrustable Professional Activity (EPA)s using an easily accessible App.

BACKGROUND:
Our institution is part of the EPA pilot study sponsored by the AAMC to explore the feasibility of teaching and assessing the core EPAs. This year direct observation and assessment of the EPAs was implemented across clerkships. Each clerkship was allowed to determine which EPAs were applicable to their field.

METHODS:
The OBGYN department determined and assessed that EPA1 (History and Physical), EPA2 (Differential Dx), EPA3 (Dx and Screening Tests) and EPA6 (Oral Presentation) were core skills to the clerkship with the following scale (1=student observed, 2=assessor had to talk the student through it, 3=assessor had direct them from time to time, and 4=assessor needed to be available just in case.).

RESULTS:
EPA 1 was 3.0 for OB vs 3.5 for other clerkships (p<.0001). For EPA 2 OB was 3.0 vs 3.4 for other clerkships (p<0.05). For EPA 3 OB was at 3.0 vs 3.4 for other clerkships (n.s). For EPA 6 OB was at 3.1 vs 3.4 for other clerkships (p<.005). For the first 3 months there were 2783 EPA assessments. The average score was 3.45. In comparison to other clerkships, students on OBGYN received lower scores in EPA 1,2,6. (P<.0001, P<.05 and P<.005) possibly indicating more stringent grading by faculty or lower performance of medical students.
For the first 3 months there were 2783 EPA assessments. The average score was 3.45. In comparison to other clerkships, students on OBGYN received lower scores in EPA 1,2,6. (P<.0001, P<.05 and P<.005) possibly indicating more stringent grading by faculty or lower performance of medical students.

DISCUSSION:
In comparison to all other clerkships combines, student on OBGYN received lower scores in all four EPAs possibly indicating more stringent grading by faculty or lower performance of medical students. Lower EPA scores may indicate more stringent grading by faculty or lower performance of medical students. This could also be related to lower numbers of overall EPAs required by the OB/GYN clerkship. Further research is needed to determine the significance of these findings.
Surgeon and Contextual Factors Influencing OB-GYN Resident Autonomy in the Operating Room
Authors: McKeon Bri Anne , Fryer Kimberly , Holmstrom Shelly , Ricciotti Hope , Kenton Kimberly 
Published: October 2019

OBJECTIVE:
Investigate surgeon and contextual factors affecting the Obstetric and Gynecology (OB-GYN) attending surgeon’s ability to promote resident autonomy in the operating room.

METHODS:
We recruited attending OB-GYN surgeons across subspecialties at one tertiary care academic center to participate in a focus group or individual interview. All focus group discussions and interviews were facilitated by a single investigator using a standardized interview guide. The focus groups and interviews included open-ended questions to probe for participants’ motivations and barriers to granting trainee autonomy. Focus group discussions and interviews were recorded, transcribed and then coded by two investigators using a data driven approach with a priori and emergent codes.

RESULTS:
Fourteen OB-GYN surgeons participated across 4 subspecialties, including 9 Generalists, 3 Gynecologic Oncologists, 1 Family Planning specialist and 1 Reproductive Endocrinology and Infertility specialist. Four thematic code groups included: surgeon, resident, procedural and contextual factors. Surgeon experience and confidence were most commonly identified contributing surgeon factors, with a high level of co-occurrence. Surgeon concerns for patient safety and case difficulty were the most commonly considered procedural factors. The resident’s technical performance and confidence in the operating room allowed for increased resident autonomy, while time constraints limited autonomy. The resident’s technical performance and surgeon concerns for patient safety had a high level of co-occurrence.

CONCLUSION:
Efforts to increase surgeon confidence and experience, while ultimately promoting a culture of patient safety, may provide a framework for optimizing faculty development efforts to support surgical education aimed at preparing residents for independent practice upon graduation.
Design of a Laparoscopic Curriculum for Obstetrics and Gynecology Residents
Authors: Rivard Colleen , Fischer John 
Published: October 2019

PROBLEM:
The American Board of Obstetrics and Gynecology (ABOG) announced in January, 2018 it is requiring completion of the Fundamentals of Laparoscopic Surgery (FLS) program as prerequisite for board certification for residents graduating after May, 2020. Currently, our residency program has no formalized laparoscopic curriculum and has never required residents to participate in the FLS program.

INTERVENTION:
Needs assessment was performed to survey faculty in the residency program regarding residents’ current skill levels and faculty perspectives of level-appropriate laparoscopic skills by training year. A comprehensive laparoscopic curriculum was designed to support resident progression through different competency milestones required to ultimately be able to perform laparoscopic hysterectomies as the surgeon. The laparoscopic curriculum addresses a parallel group of requirements designed to assist residents in successful completion of the FLS curriculum.

CONTEXT:
The laparoscopic curriculum was designed in the context of an academically-based obstetrics and gynecology residency program. The residency program has 9 residents a year who rotate at 5 different clinical sites and work with over 50 faculty who perform laparoscopic procedures.

OUTCOMES/LESSONS LEARNED:
The curriculum will be implemented in July 2019 with the new academic year. The curriculum will be assessed in several ways: formal testing of residents with FLS skills by the program administration, time takes resident to progress through the competency milestones for laparoscopy, the FLS pass rate, and scores of our residents. Main lesson learned through the design process was how to manage the varying resident and faculty expectations for surgical skills training.
PAG as a Mandatory ObGyn Training Experience in Canada: A Needs Assessment Study
Authors: Dumont Tania 
Published: October 2019

OBJECTIVE:
The primary objective was to perform a needs assessment to determine if mandatory Pediatric and Adolescent Gynecology (PAG) training experience in each Obstetrics and Gynecology (ObGyn) residency program in Canada is feasible.

METHODS:
This is a comparative descriptive design where the 16 ObGyn Residency Program Directors (PD) in Canada will undergo 20-minute phone interviews. The interviews will be recorded and will explore how PAG and Reproductive Endocrinology (RE) objectives are met in each program, PD’s awareness of PAG opportunities in North America and feasibility of a mandatory training experience. This project is REB approved.

RESULTS:
Thirteen program directors agreed to participate, and ten interviews have been completed thus far. There appears to be at least 1-2 PAG-trained ObGyn per institution with some form of mandatory training experience for residents in senior years. PD feel PAG training is important and should be mandatory; however, they report a lack resources to implement. PDs lack of knowledge of available PAG electives and fellowships offered in North America as well as numerous educational tools available to teach PAG.

CONCLUSION:
PAG training experiences should be mandatory in all programs to achieve the RCPSC PAG objectives. PAG providers are available in all Canadian training centers and efforts should be made to support these providers in delivering the educational PAG content to ObGyn residents to ensure competency in the care of young women and children. PD need to be educated on available PAG educational resources, resident electives and fellowship opportunities.
Perceptions of Alcohol Risk Among HIV/Hepatitis C Coinfected Patients
Authors: Kim Hyang Nina , Howell Abigail , Blevins Claire E. , Pinkston Megan M. , Herman Debra S. , Stein Michael D. 
Published: October 2019

Objectives:
We examined how patient perceptions of alcohol risk, provider discussions about alcohol, and treatment of hepatitis C virus (HCV) differed among HIV–HCV coinfected patients in primary care.

Methods:
Between April, 2016 and April, 2017, we conducted a screening survey with patients in an HIV primary care clinic in Seattle, Washington, who had chronic HCV coinfection or a history of chronic HCV infection who had successfully cleared their infection with treatment.

Results:
Of 225 participants, 84 (37%) were active drinkers (drank ≥2–4 times/mo in past 3 months). Of those with little to no use for ≥3 months, 65 (29%) were former drinkers with a history of alcohol use and 76 were abstainers with no such history. Former drinkers and abstainers were more likely than active drinkers to perceive that any drinking was unsafe (69% vs 58% vs 31%; P < 0.001). Former drinkers were more likely to report a physician's recommendation to stop drinking than active drinkers (63% vs 47%; P = 0.05). The great majority (87%) of former drinkers decided to stop or reduce drinking on their own (most often in response to a nonhealth life event) and only 13% acknowledged doing so on their doctor's prompting. HCV treatment was not associated with former or active drinking status.

Conclusions:
Our findings underscore the importance of educating not only HIV–HCV patients about the effects of alcohol use but also HIV clinicians about delivering consistent counseling about alcohol avoidance. Understanding the reasons that HIV–HCV coinfected persons make changes in their alcohol use could drive novel interventions that reduce the negative consequences of drinking.
Therapeutic Implications of Nitrite in Hypertension
Authors: Ling Wei Chih , Mustafa Mohd Rais , Murugan Dharmani Devi 
Published: October 2019

Abstract:
Nitrite, an anion produced from the oxidative breakdown of nitric oxide (NO), has traditionally been viewed as an inert molecule. However, this dogma has been challenged with the findings that nitrite can be readily reduced to NO under pathological conditions, hence representing a physiologically relevant storage reservoir of NO either in the blood or tissues. Nitrite administration has been demonstrated to improve myocardial function in subjects with heart failure and to lower the blood pressure in hypertensive subjects. Thus, extensive amount of work has since been carried out to investigate the therapeutic potential of nitrite in treating cardiovascular diseases, especially hypertension. Studies done on several animal models of hypertension have demonstrated the efficacy of nitrite in preventing and ameliorating the pathological changes associated with the disease. This brief review of the current findings aims to re-evaluate the use of nitrite for the treatment of hypertension and in particular to highlight its role in improving endothelial function.
Natural History of Facial Weakness Following Surgery of the Cerebellopontine Angle: A Tertiary Care Cohort
Authors: Luryi Alexander L. , Babu Seilesh , Michaelides Elias M. , Bojrab Dennis I. , Kveton John F. , Hong Robert S. , Jacob Jeffrey T. , Schutt Christopher A. 
Published: October 2019

Objective:
Facial function is a key outcome in surgery of the cerebellopontine angle (CPA). This study describes the natural history of facial weakness after CPA surgery.

Study design and setting:
Retrospective study of two tertiary centers.

Patients and intervention:
Patients undergoing surgery for CPA tumors from 2003 to 2017 with preoperatively normal facial function and without subsequent surgical or adjuvant therapy.

Main outcome measure:
Serial facial nerve examinations using the House–Brackmann (HB) scale.

Results:
Of 301 patients examined, 149 (49.5%) had facial weakness postoperatively and 74.5% of these occurred within 24 hours. Of patients with HB-1 function within 24 hours after surgery, 95.3% had HB-1 function and 100% had HB-3 or better function at last follow-up. Of patients with HB-4 or worse function within 24 hours after surgery, 22.6% ultimately achieved HB-1 function and 83.9% ultimately achieved HB-3 or better function. By 180 days postoperatively, 83.7% of patients’ facial function had stabilized. At last follow-up, 3.0% of patients had facial function poorer than HB-3, which was associated with subtotal resections (12.9% vs. 4.4% for near total and 0.6% for gross total resections, p = 0.002), aspirin use (10.6% vs. 1.6%, p = 0.001), larger tumors (p < 0.0005), longer surgery (p < 0.002), and immediate versus delayed postoperative facial weakness (p = 0.002).

Conclusions:
Facial function over time after CPA surgery is presented. While facial function immediately after surgery correlates with future function, delayed weakness or improvement is common. These data inform patient counseling both preceding and following surgery.
Albumin-bilirubin and platelet-albumin-bilirubin grades for hepatitis B-associated hepatocellular carcinoma in Child–Pugh A patients treated with radical surgery
Authors: Wu Binquan , Hu Xiaosi , Jin Hao , Zhou Lei , Zhang Dengyong , Man Zhongran , Wang Yong , Yang Song , Pang Qing , Liu Huichun , Cui Peiyuan 
Published: October 2019

Abstract
Child–Pugh (CP) grade A patients with early stage hepatocellular carcinoma (HCC) are candidates for curative surgery, while some patients still have a poor outcome. The aim of this study was to investigate the prognostic values of 2 new evaluation models for liver function, named albumin-bilirubin (ALBI) and platelet-albumin-bilirubin (PALBI) grades, in CP grade A patients with HCC.
In this retrospective cohort study, we reviewed 134 cases of CP grade A patients with hepatitis B-associated HCC who underwent radical surgery. ALBI and PALBI grades were calculated based on preoperative serologic examinations. Overall survival (OS) and recurrence-free survival (RFS) were estimated by Kaplan–Meier curve and Cox regression. The prognostic performances of the models were estimated by using the concordance index (C-index).
During a median follow-up time of 27 months, 27.6% (37/134) of patients died and 26.1% (35/134) experienced recurrence. Kaplan–Meier analyses showed that ALBI and PALBI grades were significantly associated with OS and RFS. Multivariate analyses further revealed that both ALBI and PALBI grades were independent predictors for survival. Furthermore, the prognostic values of the combination of tumor size with ALBI (C-index = 0.754, 95% confidence interval [CI]: 0.675–0.849) or with PALBI (C-index = 0.762, 95% CI: 0.664–0.844) may be comparable with both Barcelona Clinic Liver Cancer and Cancer of Liver Italian Program staging systems.
The ALBI and PALBI grades, in particular the combination with tumor size, are effective models for discriminating survival in CP grade A patients with HCC.
Comparison and predictive factors analysis for efficacy and safety of Kirschner wire, anatomical plate fixation and cannulated screw in treating patients with open calcaneal fractures
Authors: Zhao Weiguang , Zhang Yingze 
Published: October 2019

Abstract
This study aimed to compare the efficacy and safety among Kirschner wire, anatomical plate fixation and cannulated screw treatments in patients with open calcaneal fractures, and to explore the predictive factors for treatment response and complication occurrence.
The 142 open calcaneal fracture patients were enrolled in this study, who received fixation procedures of Kirschner wire, anatomical plate fixation or cannulated screw on demand. Treatment efficacy was assessed by AOFAS score and occurrence of complications was recorded.
No difference of AOFAS score was observed among Kirschner wire, anatomical plate fixation and cannulated screw groups (P = .792), and the numbers of patients with excellent, good, medium, and poor AOFAS score in Kirschner wire group were 16 (16.2%), 42 (42.4%), 32 (32.3%), and 9 (9.1%), which in anatomical plate fixation group were 4 (16.7%), 11 (45.8%), 7 (29.2%), and (8.3%), and in cannulated screw group were 1 (5.3%), 10 (52.6%), 6 (31.6%), and 2 (10.5%), respectively. No difference of total complication occurrence (P = .709) or specific complications including skin graft (P = .419), flap graft (P = .229), deep infection (P = .644) or amputation (P = .428) was discovered among 3 groups. Logistic regression analysis revealed that fixation options did not affect treatment response and complication occurrence (all P > .05), while higher Gustilo type correlates with decreased treatment response (P < .001) and elevated complication occurrence (P < .001) independently.
Kirschner wire, anatomical plate fixation, and cannulated screw are equally efficient and tolerated in treating patients with open calcaneal fractures, and higher Gustilo type correlates with decreased treatment response and increased complication occurrence independently.