bluuebunny/crossref_metadata_2025_split huggingface dataset:
Maternal Drug-related Death and Suicide are Leading Causes of Postpartum Death in California
Authors: Goldman-Mellor S. , Margerison C.E. 
Published: August 2020

(Am J Obstet Gynecol. 2019;221:489.e1–489.e9)
Efforts to reduce maternal mortality has become a priority worldwide and in the United States. In 2018, the Preventing Maternal Deaths Act was enacted to support state efforts to track and review maternal deaths. Also, targeted action plans and safety bundles for clinical care that focus on common causes of maternal mortality have been developed. Yet, there is limited evidence on the impact that drug-related deaths and suicide have on postpartum women. The aim of this study was to determine the incidence of drug-related deaths and suicide among women in California up to a year after giving birth and to examine their utilization of health care services between delivery and postpartum death.
Recovery of Physical Activity After Cesarean Delivery and Its Relationship With Pain
Authors: Sharpe E.E. , Booth J.L. , Houle T.T. , Pan P.H. , Harris L.C. , Aschenbrenner C.A. , Eisenach J.C. 
Published: August 2020

(Pain. 2019;160:2350–2357)
While all patients experience pain when recovering from a major surgery, not much is known about the day-to-day recovery from pain and inactivity that surgical patients experience. Previous research has attempted to quantify postoperative activity and pain levels, but these studies do not employ a practical approach to data collection that is both consistent and adequately detailed. The goals of this study were 4-fold: (1) characterize a feasible approach to recording exercise and pain for postoperative patients, (2) determine the connection between daily pain and levels of activity or inactivity, (3) determine the form of recovery of activity, and (4) explore factors that influence physical activity and determine if they could predict recovery time.
Introduction of a Novel System for Quantitating Blood Loss After Vaginal Delivery: A Retrospective Interrupted Time Series Analysis With Concurrent Control Group
Authors: Lumbreras-Marquez M. , Reale S.C. , Carusi D.A. , Robinson J.N. , Scharf N. , Fields K.G. , Farber M.K. 
Published: August 2020

(Anesth Analg. 2020;130:857–868)
The most preventable cause of maternal mortality worldwide is postpartum hemorrhage (PPH). Timely detection of abnormal bleeding is critical for the treatment of PPH, and the National Partnership for Maternal Safety (NPMS) recommends quantitative measurement of cumulative blood loss, as visual estimation leads to both a 30% to 50% underestimation of blood loss and a subsequent increase in the magnitude of the hemorrhage. Gravimetry is recommended by the NPMS for measuring blood loss, but as it is a multistep process involving calculation and cumulative recording, it proves difficult to perform amidst an acute bleeding circumstance. The authors hypothesized that in vaginal deliveries (VDs), the transition from visual estimation of blood loss (vBL) to gravimetric and volumetric estimation of blood loss (tBL) would yield increased odds of immediate PPH detection. This hypothesis was based on the primary aim of finding the change in odds of immediate PPH detection in VDs before and following the implementation of the tBL device [using cesarean deliveries (CDs) as a concurrent control group]. The primary outcome of the study was detection of immediate PPH (≥500 mL vBL or tBL immediately following VD, or ≥1000 mL vBL immediately following CD). Total blood loss, blood loss ≥1000 mL, secondary uterotonic use, and a composite outcome related to PPH management (such as transfusion) before and after tBL implementation were all secondary outcomes.
Managing Obstetric Hemorrhage: Is It Time for a More Personalized Approach?
Authors: Shah A. , Collis R.E. 
Published: August 2020

(Anaesthesia. 2019;74:961–964)
Worldwide, an increasing number of women are experiencing complications from major obstetric hemorrhage without an apparent comparable rise in the risk factors associated with obstetric hemorrhage. This editorial addressed a study that reported on the use of a rotational thromboelastometry (ROTEM)-guided algorithm for the management of obstetric hemorrhage. The research found a substantial improvement in patient outcomes, along with a decrease in transfusion volume, when compared with the institution’s previous practice of administering a standardized “shock pack.” This work illustrated that significant improvements in the treatment of obstetric hemorrhage can be achieved.
Assessment of Coagulation by Thromboelastography During Ongoing Postpartum Hemorrhage: A Retrospective Cohort Analysis
Authors: Rigouzzo A. , Louvet N. , Favier R. , Ore M.V. , Piana F. , Girault L. , Farrugia M. , Sabourdin N. , Constant I. 
Published: August 2020

(Anesth Analg. 2020;130:416–425)
Early detection is crucial in the management of postpartum hemorrhage (PPH), a leading global cause of maternal mortality. A fibrinogen concentration ≤2 g/L at the onset of PPH is a strong predictive factor, but measurement of fibrinogen level takes too long to obtain for decision-making. Thromboelastography (TEG) is a point of care coagulation monitor that may be able to guide management and improve outcomes in PPH patients. This study aimed to evaluate TEG parameters for accuracy in the diagnosis of coagulopathy during PPH and accuracy in the prediction of severe hemorrhage >2500 mL.
Determinants of Women’s Dissatisfaction With Anesthesia Care in Labor and Delivery
Authors: Yurashevich M. , Carvalho B. , Butwick A.J. , Ando K. , Flood P.D. 
Published: August 2020

(Anaesthesia. 2019;74:1112–1120)
Patient satisfaction has become a priority for health care organizations as it is considered a quality indicator. In the United States and other countries, payment for medical services can now be withheld by government payors for low patient satisfaction. Previous studies of patient satisfaction have been conducted in settings where anesthesiologists practice, such as ambulatory surgery centers and chronic pain clinics. However, studies assessing maternal satisfaction have not focused on obstetric anesthesia, which is quite distinct from other anesthesia practice settings based on a mostly healthy patient population undergoing a major life event. The purpose of this study was to determine factors associated with maternal dissatisfaction with anesthesia care so that interventions to improve patient care and experience can then be identified and implemented.
Maternal Cardiac Parameters Can Help in Differentiating the Clinical Profile of Preeclampsia and in Predicting Progression From Mild to Severe Forms
Authors: Di Pasquo E. , Ghi T. , Dall’Asta A. , Angeli L. , Fieni S. , Pedrazzi G. , Frusca T. 
Published: August 2020

(Am J Obstet Gynecol. 2019;221:633.e1–633.e9)
Given the impact of preeclampsia on maternal and perinatal outcomes, many studies have evaluated the pathophysiology of the disease. Studies support the hypothesis that there are 2 types: early-onset preeclampsia associated with fetal growth restriction, and late-onset preeclampsia triggered by metabolic or inflammatory maternal factors. The aim of this study was to assess the maternal hemodynamic parameters for early-onset and late-onset preeclampsia, and to determine if these cardiac findings can help to identify the disease’s severity and progression.
Six-Year Follow-up of a Trial of Antenatal Vitamin D for Asthma Reduction
Authors: Litonjua A.A. , Carey V.J. , Laranjo N. , Stubbs B.J. , Mirzakhani H. , O’Connor G.T. , Sandel M. , Beigelman A. , Bacharier L.B. , Zeiger R.S. , Schatz M. , Hollis B.W. , Weiss S.T. 
Published: August 2020

(N Engl J Med. 2020;382:525–533)
Maternal vitamin D deficiency may be a factor in the development of asthma in infants according to some observational studies. The study authors previously conducted the Vitamin D Antenatal Asthma Reduction Trial (VDAART) and reported prenatal vitamin D supplementation was associated with reduced rates of asthma and recurrent wheeze in 3-year-old children. This study reports on the follow-up of the children in the VDAART study group through their sixth birthday to determine the effects of prenatal vitamin D supplementation on the incidence of asthma and recurrent wheeze.
Retrospective Analysis of Obstetric Intensive Care Unit Admissions Reveals Differences in Etiology for Admission Based on Mode of Conception
Authors: Romano D.N. , Hyman J. , Katz D. , Knibbs N. , Einav S. , Resnick O. , Beilin Y. 
Published: August 2020

(Anesth Analg. 2020;130:436–444)
As births using assisted reproductive technology increase, the maternal and neonatal safety of these pregnancies continues to be of concern. There are established associations between assisted reproductive technology pregnancies and a number of adverse outcomes, including gestational diabetes, hypertensive disorders of pregnancy, obstetric hemorrhage, abnormal placentation, and cesarean delivery. There is a lack of studies examining the risk of intensive care unit (ICU) admission in women using assisted reproductive technology. This study compared parturients who conceived via in vitro fertilization (IVF) and those who did not in terms of etiology and course of ICU admission, particularly focusing on postpartum hemorrhage.
A Combination of Inhaled Nitrous Oxide and Low-Dose Ketamine Infusion for Labor Analgesia
Authors: Potter J. , Perez-Velasco D. , Maxymiv N.G. , Graham J. , Faircloth A. , Thakrar S. 
Published: August 2020

(J Clin Anesth. 2019;57:64–65)
While ketamine is useful in a labor analgesia setting, it is typically used infrequently due to its association with lower Apgar scores, uterine hypertonus, and maternal psychological reactions. Inhaled nitrous oxide (iNO) is another analgesia option, although it provides maternal anxiolytic effects but limited labor analgesia. Not much research has been done on using the combination of a low-dose ketamine infusion (<0.5 mg/kg/h intravenous) and iNO for labor analgesia. These authors outlined 2 cases that apply this analgesic regimen.
Effect of Ear Acupuncture on Pregnancy-related Pain in the Lower Back and Posterior Pelvic Girdle: A Multicenter Randomized Clinical Trial
Authors: Vas J. , Cintado M.C. , Aranda-Regules J.M. , Aguilar I. , Ruiz F.R. 
Published: August 2020

(Acta Obstet Gynecol Scand. 2019;98:1307–1317)
Almost half of all pregnant women experience low back pain and/or pelvic girdle pain (LBPGP), which can significantly affect their quality of life (QoL) and interfere with the ability to perform daily activities at work and at home. Interestingly, parturients in Spain have reported higher rates of lumbar pain (71.3%) and pelvic girdle pain (64.7%) than women in other countries. While many women experience pain resolution after delivery, previous studies have found that some women have persistent LBPGP up to 3 years after delivery. In addition, experiencing this pain in one pregnancy elevates the risk of developing pain in future pregnancies. There is a limited number of effective and safe pain management treatments for LBPGP in pregnant women, but research has indicated that acupuncture treatment during pregnancy reduces LBPGP and improves work function and QoL. However, the acupuncture techniques described in these studies require specialized training, thus making their availability limited. The current investigators attempted to evaluate the effectiveness of ear acupuncture, which can be performed in a primary care setting by midwives, for reducing LBPGP in pregnant patients.
Obstetric Neuraxial Anesthesia at Low Platelet Counts in the Context of Immune Thrombocytopenia: A Systematic Review and Meta-analysis
Authors: Bailey L.J. , Nadine Shehata N. , De France B. , Carvalho J.C.A. , Malinowski A.K. 
Published: August 2020

(Can J Anesth. 2019;66:1396–1414)
Immune thrombocytopenia purpura (ITP) is a rare autoimmune condition marked by a low platelet count, typically <100×109/L. It may initially present during the preconception or antenatal periods. Most women are asymptomatic, but some may experience epistaxis, petechiae, easy bruising, or mucosal bleeding. Consensus on a safe threshold for platelet counts for placement of neuraxial anesthesia in pregnancy is unclear. The American Society of Anesthesiologists recommends an individualized approach to determine the risk of excessive bleeding without suggesting a minimum platelet threshold. The aim of this study was to examine obstetric neuraxial anesthesia (OBNA) outcomes in patients with platelet counts <100×109/L in the context of primary ITP.
Transversus Abdominis Plane Block and Intrathecal Morphine Use in Cesarean Section: A Retrospective Review
Authors: Cole J. , Hughey S. , Longwell J. 
Published: August 2020

(Reg Anesth Pain Med. 2019;44:1035–1037)
In women undergoing cesarean delivery, the anesthesia technique is most commonly spinal or epidural anesthesia. Postoperative pain is most frequently managed by administering morphine into the intrathecal or epidural space. However, transversus abdominis plane (TAP) block can also be utilized. While both modalities, used separately, have been shown to be effective in managing pain after surgery, the literature on the combined use of intrathecal morphine and TAP block needs further investigation. The aim of this study was to evaluate whether the TAP block in combination with intrathecal morphine delays the need to initiate opioid administration following cesarean delivery under spinal anesthesia, versus intrathecal morphine alone.
The Impact of Occupational Activities During Pregnancy on Pregnancy Outcomes: A Systematic Review and Metaanalysis
Authors: Cai Chenxi , Vandermeer Ben , Khurana Rshmi , Nerenberg Kara , Featherstone Robin , Sebastianski Meghan , Davenport Margie H. 
Published: August 2020

(Abstracted from Am J Obstet Gynecol 2020;222(3):224–238)
Many women engage in work that is physically demanding. Work that includes carrying heavy loads or working in tiring or painful positions has been associated with adverse outcomes in pregnancy, such as preterm delivery and miscarriage.
Optimizing Medical Student Clerkship Schedules Using a Novel Application of the Hungarian Algorithm
Authors: MacLean Matthew T. , Lysikowski Jerzy R. , Rege Robert V. , Sendelbach Dorothy M. , Mihalic Angela P. 
Published: August 2020

Problem
Medical students often have preferences regarding the order of their clinical rotations, but assigning rotations fairly and efficiently can be challenging. To achieve a solution that optimizes assignments (i.e., maximizes student satisfaction), the authors present a novel application of the Hungarian algorithm, designed at the University of Texas Southwestern Medical Center (UTSW), to assign student schedules.

Approach
Possible schedules were divided into distinct pathway options with k total number of seats. Each of n students submitted a ranked list of their top 5 pathway choices. An n × k matrix was formed, where the location (i, j) represented the cost associated with student i being placed in seat j. Progressively higher costs were assigned to students receiving less desired pathways. The Hungarian algorithm was then used to find the assignments that minimize total cost. The authors compared the performance of the Hungarian algorithm against 2 alternative algorithms (i.e., the rank and lottery algorithms). To evaluate the 3 algorithms, 4 simulations were conducted with different popularity weights for different pathways and were run across 1,000 trials. The algorithms were also compared using 3 years of UTSW student preference data for the classes of 2019, 2020, and 2021.

Outcomes
In all 4 computer simulations, the Hungarian algorithm resulted in more students receiving 1 of their top 3 choices and fewer students receiving none of their preferences. Similarly, for UTSW student preference data, the Hungarian algorithm resulted in more students receiving 1 of their top 3 preferences and fewer students receiving none of their ranked preferences.

Next Steps
This approach may be broadly applied to scheduling challenges in undergraduate and graduate medical education. Furthermore, by manipulating cost values, additional constraints can be enforced (e.g., requiring certain seats to be filled, attempting to avoid schedules that begin with a student’s desired specialty).
Double standards: why is pulse oximetry standard care, whereas tissue oximetry is not?
Authors: Zhao Xu , Xiao Huaping , Cai Junying , Meng Lingzhong 
Published: August 2020

Purpose of review
Why is pulse oximetry a standard monitor, whereas tissue oximeter is not? Is this a double-standard treatment?

Recent findings
There appears to be a lack of enthusiasm for a continual investigation into whether the use of pulse oximetry leads to reduced morbidity and mortality in acute care although there is no robust evidence attesting to its outcome benefits. In contrast, research investigating the outcome effectiveness of tissue oximetry-guided care is consistently ongoing. A recent randomized controlled trial involving 800 patients who underwent laparoscopic hysterectomy found that, although muscular tissue oxygen saturation-guided care did not reduce the overall occurrence of postoperative nausea and vomiting for all patients, it did reduce the occurrence of these symptoms in patients who had a body mass index ≥25. It was also observed that muscular tissue oxygen saturation increases when blood pressure falls following the administration of nicardipine. These studies highlight the persistence of interest in understanding the value of tissue oximetry in patient care.

Summary
Pulse oximetry and tissue oximetry are treated differently although neither monitor has robust evidence attesting to its outcome benefits. This difference may root in the difference in the physiology they monitor, the cost, the ease of use/interpretation/intervention and the relevance to patient safety and care quality. Pulse oxygen saturation represents a vital sign, whereas tissue oxygen saturation is likely a quality sign; however, further research endeavors are required to fully understand how to best use tissue oximetry.
Changing Outdated Methadone Regulations That Harm Pregnant Patients
Authors: McCarthy John J. , Jones Hendree E. , Terplan Mishka , Rudolf Vania P. , von Klimo Melinda Campopiano 
Published: August 2020

Methadone regulations have changed minimally since 1974, despite advances in the understanding of the nature of opioid use disorder (OUD) and the role of medications in its treatment. At that time, most patients with OUD were considered to have anti-social personality disorders and the regulations aimed to exert maximal control over medication access. Six- or seven-day clinic attendance is required for months, regardless of distance, or childcare and other social responsibilities. Take home medications are not allowed unless rigid and formulaic conditions are met. Although addiction medicine has rejected the “criminal” paradigm in favor of OUD as a treatable medical disorder, methadone regulations have not kept pace with the science.
Pregnancy is characterized by an ultra-rapid metabolic state, but regulations prevent the use of daily divided doses of methadone to maintain stability. This results in repeated episodes of maternal/fetal opioid withdrawal, as well as other fetal physiologic abnormalities. Interference with dose regimen adjustments prevents optimal outcomes.
Further, methadone clinics are mostly urban, leaving patients in rural areas without access. This led to excessive morbidity and mortality when the opioid crisis hit. The response of merely expanding capacity in overcrowded urban clinics created a contagion menace when Covid-19 arrived. Pregnant women (and parents with children) were forced to negotiate dosing in dangerous conditions.
A revised methadone system must provide treatment that is local, flexible, and limited in size to manage viral contagion risks. This regulatory change can most easily be started by changing regulations that adversely affect pregnant women.
Modiolar Proximity of Slim Modiolar Electrodes and Cochlear Duct Length: Correlation for Potential Basis of Customized Cochlear Implantation With Perimodiolar Electrodes
Authors: Lee Sang-Yeon , Jung Bae Yun , Carandang Marge , Kim Yoonjoong , Hee Han Jin , Huh Gene , Song Jae-Jin , Koo Ja-Won , Ho Lee Jun , Ha Oh Seung , Choi Byung Yoon 
Published: August 2020

Objectives:
Recent studies have shown that cochlear duct length (CDL) varies among individuals and could significantly influence the final position of the electrode and its trajectory in the cochlea. Given this, we hypothesized that the degree of modiolar proximity of novel slim modiolar electrodes, such as CI532 and CI632, can also be affected by CDL. To test this hypothesis, we retrospectively evaluated individual CDL to determine if there is any significant correlation of CDL with degree of modiolar proximity.

Methods:
Fifty-one ears from 38 subjects implanted with slim modiolar electrodes by a single surgeon through the round window approach using the pull-back technique were included. Our cohort was classified according to the deafness onset (congenital versus postlingual) and the degree of modiolar proximity (less versus tight) with reference to the spiral diameter made by the slim modiolar electrodes in situ on transorbital x ray. We then analyzed the CDL and its metrics using a readily available surgical preplanning tool (OTOPLAN) to obtain comparable data.

Results:
Among 30 ears associated with congenital deafness, 9 ears (30%) showed less modiolar proximity, while none of the 21 ears from 19 subjects with postlingual deafness exhibited “less modiolar proximity” based on our criteria. In this study, CDL showed significant variation among subjects. Importantly, a significant inverse correlation between spiral diameter and CDL (ρ = −0.581, p < 0.001) was found, showing that shorter CDLs have longer spiral diameter and less modiolar proximity. Moreover, further pull-back technique characterized by pulling out the electrode a little bit more in cases with shorter CDL, if not always, exhibited tighter modiolar proximity.

Conclusion:
A preponderance of less modiolar proximity of the electrode was observed exclusively among congenital deafness cases, demonstrated by a less tight spiral configuration even under the pull-back technique. Our data suggest that shorter CDL is associated with a less tight spiral configuration of slim modiolar electrodes postoperatively. Depending on the insertion technique, the differential degree of modiolar proximity of slim modiolar electrodes can be alleviated in cases with short CDL, which justifies cochlear duct length-based customized insertion of slim modiolar electrodes.