bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhanced Recovery After Surgery Among Obese Gynecology Oncology Patients [08H]
Authors: Kent Laura M. , Buras Andrea , Zhu Alina , Mallen Adrianne , Chern Jing Yi 
Published: April 2020

INTRODUCTION:
Benefits of Enhanced Recovery After Surgery (ERAS) protocols are well-established for the general surgical population, but there is limited studies specifically evaluating the efficacy in obese patients. We implemented an ERAS protocol among gynecologic oncology patients undergoing laparotomy and assessed outcomes in obese (≥30) vs non-obese.

METHODS:
The gynecologic oncology department implemented an ERAS protocol as a quality improvement initiative in patients undergoing laparotomy. Data was prospectively collected on patients where ERAS was implemented and compared to historical controls (pre-ERAS). A descriptive analysis on outcomes was assessed by comparing obese (BMI>30) and non-obese patients.

RESULTS:
The average length of stay (LOS) in ERAS vs pre-ERAS is 3.5 days vs 4.7 days (P=.002). Non-obese ERAS vs pre–ERAS LOS 3.2 days vs 4.6 days (P=.05). However, obese patients tend to have longer LOS, 3.2 days vs 3.8 days (NS). Although PO analgesics were used per ERAS protocol, obese patients used patient-controlled analgesia (PCA) more often than non-obese patients (13% vs 3%). The rate of complications (9-15%) and readmissions (0-5%) was similar among all groups.

CONCLUSION:
ERAS is effective, but there is a trend towards increased LOS and PCA usage in obese patients; though there is no difference in post-op complications and readmissions. Further investigation is needed to determine how obesity affects recovery after surgery.
Factors Influencing Postoperative Morbidity in Women Undergoing Excisional Procedures of the Cervix [09H]
Authors: Davis William , Bilbao Michelle , O'Laughlin Andie , Fleischer Lindsay , Gabriel Cosette , Aikins James 
Published: April 2020

INTRODUCTION:
Pain, discharge, and bleeding are common after excisional procedures of the cervix. While generally benign, they can herald complications. Our hypothesis was that age, prophylactic antibiotics, smoking and/or diabetes might be associated with these postoperative concerns.

METHODS:
Medical records for women undergoing excisional or ablative procedures of the cervix at Cooper University Hospital from January 2013 to December 2018 were reviewed. There were 621 total subjects. Seventy-eight were excluded due to inadequate follow-up, yielding 543 analyzable procedures. Records were reviewed for pain, discharge, and bleeding. Subsequent interventions were then recorded. Age, smoking status, procedure type, prophylactic vaginal metronidazole usage (off-label) as well as smoking and diabetic history were collected. Descriptive data are reported as such, and proportions were analyzed via chi-squared tests.

RESULTS:
The average age of our subjects was 40.28 years (median 36.9, standard deviation 12.4). In total, 208 women re-presented with at least one postoperative concern following their procedure. Of these, 103 required intervention. Procedure type, postoperative prophylactic antibiotic usage (n=38), age greater than the median, and active smoking status (n=115) failed to predict postoperative complications. Former smokers (n=129, P=.047) did report more concerns, although they did not require more interventions (P=.14).

CONCLUSION:
Excisional and ablative procedures of the cervix are essential for the prevention of cervical cancer in patients with moderate to severe cervical dysplasia. Postoperative complaints of pain, bleeding and discharge are common and bothersome for patients. Based on our retrospective review, age, prophylactic vaginal metronidazole, smoking and diabetes were not associated with worse postoperative outcomes.
Knowledge and Attitudes Towards Human Papillomavirus (HPV) Testing and Vaccination at an Urban Health Clinic [10H]
Authors: Almeida Tawany , Casey Frances 
Published: April 2020

INTRODUCTION:
According to the most recent data from the U.S. Centers for Disease Control and Prevention, Latinos have higher rates of human papillomavirus (HPV) associated cancers when compared to the general population. Individuals who lack knowledge about HPV and its association with cancer may not understand the importance of preventing infection and may have less access to vaccination. This study aims to assess the knowledge regarding HPV transmission and perception of HPV vaccination in a Latino health clinic.

METHODS:
In this cross-sectional survey, a convenience sample of Latino participants in an urban free health clinic completed a survey in Spanish evaluating demographics and knowledge regarding the human papillomavirus disease, testing and vaccination using a previously validated questionnaire. Demographic characteristics were compared using chi-square and Fisher exact tests for HPV knowledge outcomes.

RESULTS:
Responses were obtained from 48 participants, 62.5% female and 37.5% male with mean age 37. 56% of the population studied had heard of HPV with only 27.8% of the males surveyed and only 33% of the population with a middle school education or less stating they had heard of HPV. A large percentage (81.5%) believed HPV could be cured with antibiotics or that if a woman tested positive for HPV she would definitely have a diagnosis of cervical cancer (45.5%).

CONCLUSION:
A large percentage of population surveyed had little knowledge about HPV testing and vaccination. Follow up research is needed to evaluate best methods/practice for dissemination of information and ensuring access to the HPV vaccine.
Nationwide Trends of Bowel Obstruction and Intussusception in Endometriosis Patients [11H]
Authors: Aldhaheri Sarah , Badeghiesh Ahmad , Suarthana Eva , Gil Yaron , Tulandi Togas 
Published: April 2020

INTRODUCTION:
One of the complications of endometriosis rarely described is bowel obstruction (BO). The purpose of our study was to evaluate the incidence of BO among women with endometriosis, the trend and the demographic characteristics.

METHODS:
We used the data from the Healthcare Cost and Utilization Project—Nationwide Inpatient Sample (HCUP-NIS). We studied women with endometriosis aged 15 to 55-years from 2005-2014. Those with neoplasms in the genitourinary or gastrointestinal system were excluded.

RESULTS:
Of a total 278,613 women with endometriosis, 1386 had BO or intussusception resulting in an overall incidence of 0.5%. Although the number of hospital admission related to endometriosis were decreasing, there was a significant increase in the incidence of bowel obstruction/intussusception during the time period from 0.3% to 0.9%. Moreover, women with BO tend to be white and with higher income (P<.05). The incidence of BO in those with endometriosis in the pelvic/peritoneum and the intestine were comparable. Also, those with BO tend to have lower BMI (P<.05). In addition, there was no association between diabetes mellitus, hypertension, dyslipidemia or hospital region, and the incidence of BO.

CONCLUSION:
Although there is a downtrend in the incidence of hospital admission related to endometriosis, the incidence of endometriosis specifically in the intestine or the rectovaginal wall as well as the incidence of bowel obstruction has been slightly increasing.
Pulmonary Leiomyomatosis Following Laparoscopic Myoma Morcellation [13H]
Authors: Stemmer Shlomo M. 
Published: April 2020

INTRODUCTION:
To report a case of a metastasizing myoma to the lungs diagnosed ten years following laparoscopic myoma morcellation, and review of the literature.

METHODS:
A 38 years old G3P1A2 underwent laparoscopic morcellation of a subserosal 5.5 cm myoma in 2003. Ten years later she presented with dyspnea and chest discomfort. CT chest images showed possible progressive metastatic disease from an unknown primary. Lingular wedge left lung resection revealed features compatible with metastatic leiomyoma. The pathological slides from the original myoma morcellation were reviewed and confirmed myoma origin of lung tumors. Review of the literature in PubMed (MEDLINE) for similar cases was conducted.

RESULTS:
Pulmonary benign metastasizing leiomyoma (BML) is rare and has been reported following hysterectomy and in women with leiomyoma uteri. Laparoscopic morcellation has been associated with parasitic myomas with an overall incidence of 0.12-.095%. To the best of my knowledge there are no reports of pulmonary benign metastasizing leiomyoma associated with laparoscopic morcellation.

CONCLUSION:
Complications from laparoscopic myoma morcellation are well documented, and resulted in restrictions in use of morcellators due to concerns of spreading leiomyosarcoma. The incidence of metastasizing leiomyomas to the lungs following laparoscopic myoma morcellation is presently unknown. Knowledge about benign metastasizing leiomyomas, imitating a malignant neoplasm such as lung cancer, is important to avoid over treatment and reassure the patient.
An Unusual Type of Lymphomatoid Papulosis Presenting in Pregnancy: Risk-Benefit Analysis of Antepartum Treatment [18H]
Authors: Carney Alexandra C. , Wilson Karen L. , Heuer Christopher W. 
Published: April 2020

INTRODUCTION:
Lymphomatoid papulosis (LyP) has an incidence of 2 per 1,000,000 and is associated with lymphoproliferative disorders. Type E, characterized by angioinvasion, is the rarest subtype and is associated with CD30 and CD8 expression. LyP is associated with immune compromising disorders, making pregnancy a potential setting for presentation. We present one of the first cases of LyP type E in pregnancy.

METHODS:
Case: 30-year-old G5P3, with a pregnancy complicated by a history of hemolysis, elevated liver enzymes and low platelet count syndrome in a previous pregnancy, presented in early pregnancy with a two month history of diffuse painful skin lesions. As the pregnancy progressed, the lesions spread and would blister and ulcerate before resolving. Biopsy returned with CD30+ angioinvasive LyP type E. Prednisone and topical steroids provided minimal symptomatic improvement. Peginterferon alfa-2a was offered as an alternative therapy; however, was deferred until after delivery.

CONCLUSION:
Appropriate diagnosis of LyP and subtype as well as multi-disciplinary follow-up is essential given possible associated lymphoproliferative disorders. Treatment may involve more risk than benefit and has not been proven to prevent associated malignancy necessitating individualized risk-benefit analysis. Conservative treatment is preferred, even in significantly symptomatic pregnant patients. In some severely symptomatic patients, peginterferon alfa-2a may be considered with a better safety profile compared to other agents in pregnancy. The angiodestructive nature of type E may be associated with pregnancy complications including those on the preeclampsia spectrum. These pregnancies may require closer monitoring and the consideration of aspirin prophylaxis. Early diagnostic biopsy will allow for timely intervention.
A Risky Excess? Opioid Use, Storage, and Disposal Practices Among Post-operative Gynecologic Oncology Patients [21H]
Authors: Kunycky Christina , Nickerson Ciarra , Leung Katherine , Pelkofski Elizabeth , Zweizig Susan , Korets Sharmilee 
Published: April 2020

INTRODUCTION:
Inappropriate storage and disposal of unused opioids presents a growing public health and safety issue. This is of special interest when caring for women undergoing surgery for gynecologic conditions, such as cancer, as there is increasing evidence of overprescribing in the post-operative period. This study investigates opioid storage and disposal practices among post-operative gynecologic oncology patients.

METHODS:
We developed and administered a cross-sectional survey among patients who underwent surgery for gynecologic cancer or cancer precursors between October 2017–January 2019. The survey tool assessed self-reported opioid use, storage, and disposal practices as defined according to FDA guidelines. Additional data was abstracted regarding inpatient opioid requirement prior to discharge and baseline risks factors for opioid misuse. IRB approval was obtained.

RESULTS:
297 patients met inclusion criteria. The average opioid requirement on the day of discharge was 12.9 MME (morphine milligram equivalents) with average discharge amount prescribed being 180.4 MME. 70.4% reported use of 50% or less of the opioids prescribed, and 62% reported keeping their unused opioids. 75% reported unsafe storage. 26% reported personally using leftover opioid pain medication for reasons unrelated to the surgery. Only 30.4% reported using a designated drop site for opioid disposal. Only 38.3% recalled receiving information on safe opioid storage and disposal during their care.

CONCLUSION:
There is significant overprescribing of opioids in gynecologic oncology patients postoperatively. Increased collaborative patient and prescriber education regarding safe opioid storage and disposal is paramount for future efforts to prevent diversion, accidental ingestion, and chronic opioid use.
Cerebellar Hemangioblastoma Management in Pregnancy: A Case Report [20H]
Authors: Hattink Cantey , Martinuzzi Kurt , Krishna Iris , Platner Marissa H. 
Published: April 2020

INTRODUCTION:
We present a rare case of sporadic cerebellar hemangioblastoma diagnosed in pregnancy.

METHODS:
A 37-year-old gravida 3 para 2002 with no significant history reported nausea and throbbing, bitemporal headaches at her 15 week visit. They were most bothersome in the evenings and upon waking. At her 21 week visit she reported persistent headaches with new onset dizziness. An echocardiogram and laboratory studies were normal. She was referred to neurology. At 23 weeks she had right and left beating nystagmus on exam and an unsteady gait. MRI revealed a 4 cm cystic lesion within the right cerebellum, mass effect on the fourth ventricle, and mild hydrocephalus with tonsillar and upward transtentorial herniation consistent with a hemangioblastoma. Neurosurgery planned urgent craniotomy and resection.

RESULTS:
The patient underwent uncomplicated surgery and pathology confirmed hemangioblastoma. Her postoperative course was uneventful with reassuring fetal status throughout admission. Her balance was markedly improved and neurologic exam was normal four weeks postoperatively. Testing for Von Hippel-Lindau syndrome was negative. The remainder of her pregnancy was uncomplicated. The team determined that she was a candidate for vaginal delivery. She underwent elective induction of labor at 39 weeks and progressed to vaginal delivery of a healthy female infant weighing 3370 g with Apgar scores of 9 and 9. She was discharged home with her infant on postpartum day one.

CONCLUSION:
Headaches, vomiting, and dizziness are common in pregnancy. Patients with severe, unrelenting symptoms require imaging and neurology consultation. Excellent outcomes are possible with a multidisciplinary approach involving obstetrics, maternal fetal medicine, neurology, and neurosurgery.
Decreased Narcotic Use After the Implementation of ERAS Guidelines in Gynecologic Oncology at an Academic Center [24H]
Authors: Plasencia Elizabeth , Mamani Semiramis Carbajal , Schweer David , Goicoechea Joel Cardenas 
Published: April 2020

INTRODUCTION:
The Enhanced Recovery after Surgery (ERAS) program was made to provide a standard approach to pre- and post-operative care in order to decrease narcotics requirements for surgical pain. Also, improve peri-operative outcomes such as surgical complications, and readmission rates.

Objective:
To assess the impact on narcotic use before and after ERAS in gynecologic oncology patients.

METHODS:
IRB approved study. Retrospective cohort study in patients with newly diagnose endometrial cancer who underwent robotic assisted laparoscopic surgery from May 2016 to February 2019 at an Academic Center. Patient’s narcotic used, demographics, surgical outcomes, intra- and post-operative complications, blood loss, pain medication administered, length of stay, and hospital readmission was analyzed.

RESULTS:
One hundred thirty nine patients met study criteria. Forty-three and ninety-six patients were before and after the implementation of ERAS. Both groups were similar regarding demographics, age, body mass index, comorbidities, cancer histology, grade and stage. Narcotic use was significantly decreased in patients after ERAS introduction (26.73 vs 45.53 morphine equivalents, 95% CI 30.79 to 56.3; P=.008). The post-ERAS cohort also had increased use of multimodal drug therapy for pain (85% vs 63%, n=0.004) and increase gabapentin (12% vs 62%, P=.000) and NSAID use. (36% vs 16%, P=.017). ERAS introduction did not result in decreased length of stay, hospital readmissions, or surgical complications.

CONCLUSION:
ERAS incorporation decreased narcotics used and increased multimodal drug use for postoperative pain without compromising peri-operative outcomes.
Endometriosis Associated Ovarian Cancer: A Single Gynecologic Oncology Practice [25H]
Authors: White Michael , Retes Benjamin Z. , Nezhat Farr 
Published: April 2020

INTRODUCTION:
There is increasing evidence of the association between endometriosis and ovarian cancer. Data is limited regarding stage, subtype, and recurrence for this specific subset of patients. We report and analyze findings from cases with histologically confirmed ovarian cancer associated with endometriosis at time of surgery.

METHODS:
Retrospective review surgical cases from a single gynecologic oncology practice between 2003-2019. Selection criteria of surgical cases included final pathology reports showing endometriosis and ovarian malignancy with adequate follow up.

RESULTS:
31 cases were diagnosed. Average patient age was 52.4 (29-83). Histologic subtypes diagnosed were high grade serous 9/31 patients (29%), clear cell 12/31 patients (39%), endometrioid 8/31 (26%), and mucinous 2/31 (6%). Surgical staging ranged from 1A-IIIC. 18/31 patients (58%) were diagnosed with Stage I (A: 6, B: 1, C: 11), 5/31 patients (16%) with Stage II, 8/31 patients (26%) with Stage III. All patients underwent surgical staging/debulking with 5 patients (15%) receiving neoadjuvant chemotherapy. 28/31 patients (90%) received adjuvant chemotherapy with Carboplatin/Taxol while 3/31 patients (10%) did not require further treatment. Surgical staging/debulking was performed by Laparotomy 6/31 patients (19%) or Laparoscopy/Robotic 24/31 patients (78%) with 1 case converted to Laparotomy (3%). Recurrence noted with clear cell histology 6/10 (60%) all stage I, high grade serous 3/10 (30%) all stage IIIC, and mucinous 1/10 (10%) stage I.

CONCLUSION:
The most common endometriosis associated ovarian cancers were early stage clear cell and endometrioid subtypes. Clear cell histology in spite of early stage was the most significant factor for recurrence.
Adverse Neonatal Outcomes Associated With Pregestational Diabetes in Infants Born Premature [08F]
Authors: Tse Beverly , Yao Ruofan 
Published: April 2020

INTRODUCTION:
Pregestational diabetes (PGDM) is a known risk factor for preterm delivery. It is unclear if infants born preterm to PGDM mothers are at higher risk of adverse outcomes compared to other premature infants. The objective of this study is to quantify the neonatal complications associated with PGDM in infants born premature.

METHODS:
This was a retrospective cohort study of all non-anomalous singleton neonates born in Texas from 2006-2014. Analysis was limited to births between 24 and 36 weeks gestation. Results were stratified by PGDM status. Neonatal outcomes of interest included infant death, neonatal intensive care unit (NICU) admission, low 5 minute APGAR scores, assisted ventilation >6 hrs, surfactant administration and seizures. Multivariate logistic regression analysis was performed to estimate the association between PGDM and neonatal outcomes controlling for potential confounding variables.

RESULTS:
After exclusions, 277,210 births were analyzed. The prevalence of PGDM was 1.5%. In infants born premature, PGDM was associated with an increased risk of infant death (2.3% vs. 2.0%, aOR 1.39; 95% CI [1.12, 1.73]), risk of low 5 min Apgar score (8.1% vs. 6.2%, aOR 1.50; 95% CI [1.33, 1.70]), risk of prolonged assisted ventilation (9.4% vs. 6.2%, aOR 1.61; 95% CI [1.44, 1.80]), risk of requiring surfactant treatment (3.1% vs. 2.1%, aOR 1.61; 95% CI [1.33, 1.93]), risk of NICU admission (49.4% vs. 036.1%, aOR 1.72; 95% CI [1.61, 1.84]) and risk of seizures (0.19% vs. 0.06%, aOR 3.06; 95% CI [1.49, 6.29]).

CONCLUSION:
PGDM is associated with high risk of neonatal adverse outcomes in infants born premature.
Discrepancies in Prenatal Urine Drug Screening During Marijuana Legalization in Washington State [12F]
Authors: Pflugeisen Bethann M. , Mou Jin , Straub Heather , Drennan Kathryn 
Published: April 2020

INTRODUCTION:
This study evaluated demographic patterns related to prenatal cannabinoid urine drug screening (UDS) over a five-year period during which recreational marijuana was legalized and became accessible in Washington State.

METHODS:
Using electronic health record data, we performed a retrospective analysis for deliveries occurring between the 20 months prior to legalization and following legal accessibility. For three cohorts of women (delivering prior to, between, and following legalization and accessibility), the UDS completion rate and screening demographic characteristics were assessed using Chi-squared tests and multivariate logistic regression.

RESULTS:
25,514 deliveries occurred between March 2011 and March 2016. Significantly more women underwent UDS post-accessibility (24.5%) compared to pre-legalization (20.0%, P<.001). A corresponding increase was not observed in marijuana-positive UDS in tested patients (22.7% vs. 23.3%, P=.86). African American women were more likely than women of any other race to be screened (aOROtherRace=1.4, aORWhite=1.7, aORAsian=2.1, and aORLatina=2.8, all P<.001). Odds of positive UDS increased only for white women following legalization (aOR 1.29, 95% CI 1.05-1.59, P=.02), but not for any other race. Subsidized insurance status was strongly associated with increased likelihood of testing (aOR 3.5, P<.001).

CONCLUSION:
Prenatal UDS patterns changed as policy surrounding recreational marijuana possession and accessibility evolved. Demographic discrepancies in testing reveal biases related to race and insurance status. As such they are potential contributors to health outcome disparities. It is important for providers of healthcare and health care systems to examine their practices and ensure they are being equally and justly applied.