bluuebunny/crossref_metadata_2025_split huggingface dataset:
Zika Care Connect: Establishing a Provider Network for the Management of Zika Virus [5K]
Authors: Oduyebo Titilope , Viens Laura , Rechtman Lindsay , Ritsick Maggie , Hillard Christina , Meaney-Delman Dana 
Published: April 2018

INTRODUCTION:
Access to healthcare providers with expertise in managing women with Zika virus exposure during pregnancy is critical to ensure appropriate and coordinated care, and to optimize the prenatal identification of potentially affected infants. Early diagnosis and prompt initiation of care for infants and families has the potential to mitigate the long-term impacts of Zika. Additionally, mental health services can provide support to affected families.

METHODS:
In 2017, the Zika Care Connect (ZCC) program established a provider network by identifying and enrolling providers with expertise in the management of Zika virus. ZCC engaged professional healthcare associations, health departments, and healthcare systems in 20 at-risk jurisdictions, selected based on the distribution of known Zika virus cases. Providers were contacted by phone to gauge willingness and interest; these providers could voluntarily self-enroll in the network and receive up-to-date information about emerging data on Zika virus.

RESULTS:
As of September 13, 2017, 536 total specialists are enrolled in the network, including maternal-fetal medicine (137) and obstetrics/gynecology (30). Additional specialties are care coordination, developmental pediatrics, endocrinology, infectious diseases, mental health, pediatric neurology, pediatric ophthalmology, and radiology. Data analysis regarding characteristics and geographic distribution of providers, type of practice setting, and ability to offer coordinated care is ongoing.

CONCLUSION:
ZCC establishes a network of specialty providers dedicated to the care of families affected by Zika virus. The network is designed to help families identify local providers and healthcare services, and ensure long-term follow-up. This network can also help primary care providers identify local specialist care.
Uncovering State Sharing Practices for Birth Method-of-Delivery Data in the United States [6K]
Authors: Bradley Danielle , Landau Erin , Jesani Noreen , Baron Alex , Wolfberg Adam 
Published: April 2018

INTRODUCTION:
Enabling the work of practitioners and policy makers aiming to address the US cesarean epidemic requires publicly-available, reliable, hospital-level data for birth method-of-delivery to be made available. With hospital choice being a primary determinant of birth method-of-delivery, the need for quality data to inform patient decision-making and encourage provider behavior change has never been more pertinent.

METHODS:
Reporting of birth counts and delivery methods is mandated in the US. To collect quality metric data, the investigators searched state websites and contacted vital statistics departments. States and regions were scored based on “sharing” and “barrier” metrics. “Sharing” refers to level of data shared, while “barrier” refers to data collection limitations.

RESULTS:
Twenty-eight states offered hospital-level data. Others offered method-of-delivery data on a county-of-birth-occurrence-level (10), a county-of-mother's-residence-level (6), or did not provide data (6+D.C.). Of the 44 states that shared data, 12 required a signed data use form, which outlined stipulations and limitations for data use. The West achieved the best data availability scores, while the Midwest region ranked the poorest.

CONCLUSION:
Twenty-two states and D.C. failed to share hospital-level data for method-of-delivery. Of the 28 states that shared hospital-level data, a minimum of seven do not allow public sharing of their data. Selecting a hospital based on quality metric data would improve patient outcomes, reduce the national cesarean rate, and help control healthcare costs. Availability of method-of-delivery data was highly variable across the country, contributing to the lack of transparency in the US healthcare system.
Evaluating Technology-Enabled Care Coordination During Prenatal Care for an Underserved Population [14K]
Authors: Dorton Benjamin J. , Veit Stephanie , Kleist Gina , Kuiper Jodie , Malmberg Amanda Speck 
Published: April 2018

INTRODUCTION:
Care coordination can be impactful in improving quality of care for patients and improving healthcare system efficiency. This natural history study evaluates the impact of a technology-enabled care coordination system, Babyscripts Care Navigator (Babyscripts), and the effect on prenatal care attendance as well as identifying modifiable socioeconomic risk factors in an underserved, urban obstetrical population.

METHODS:
This study included 21 patients >17 year old at their first obstetrical visit. Patients were asked to participate at their first obstetrical visit and were monitored until 6 weeks after delivery. Patients were given Babyscripts, a mobile application with bidirectional messaging support from a care coordinator. Patients received daily prenatal information and real-time support ranging from informational to emotional. Empirical data was collected by monitoring 1) appointments attended or rescheduled, 2) messages sent between patients and care coordinator, and 3) modifiable, socioeconomic risk factors identified and triaged.

RESULTS:
As of September 3, 2017, 87.5% of scheduled appointments were attended or rescheduled. The average number of routine prenatal appointments attended was 7.4, compared to the practice average of 3.2 appointments. On average, 277 messages were sent between each patient and care coordinator; 18.7% originated from patients. Thirty-nine modifiable, socioeconomic factors were identified and triaged to clinical staff (15), social work staff (7), state assistance services (8), local non-profits (6), and transportation services (3).

CONCLUSION:
Technology-enabled care coordination improved attendance at prenatal care visits and provided a reliable and efficient system that was successfully implemented within an underserved, urban obstetrical population.
Therapeutic Substitution: A Cogent Response to Opioid Induced Neonatal Abstinence Syndrome (NAS) Crisis [17K]
Authors: Calhoun Byron C. , Patel Akhil , Dietz Paul , Casto Angela , DePond Jennifer , Seybold Dara 
Published: April 2018

INTRODUCTION:
From July 1, 2016 to June 30, 2017 a total of 582 new obstetrical patients were seen in a resident service clinic in the Women's Medicine Center (WMC) at a tertiary care center with 52 (8.9%) screening positive for opiates by urine drug screening. These 52 patients were all offered outpatient therapeutic substitution in an obstetrical-addictions combined clinic to obtain abstinence with oral buprenorphine in a medicated tapering protocol.

METHODS:
Prospective observational study of patients receiving oral buprenorphine to obtain abstinence from July 1, 2016 to June 30, 2017 at tertiary care center.

RESULTS:
Of the 52 patients, 20 (38.5%) transferred to other maintenance programs, 11 (21.2%) patients sustained spontaneous miscarriages, 10 (19.2%) were lost to follow up, and three (5.8%) declined enrollment. Eight patients (15%) who enrolled completed the outpatient program. A total of 4 (50%) of babies were born neonatal abstinence (NAS) free, with 3 (100%) from mothers reaching abstinence by time of birth. In comparison, only 1 out of the 5 (20%) babies born to mothers who did not reach abstinence was NAS free. No adverse outcomes were noted in any patients or neonates who entered and/or completed the program. Cost savings for the 3 neonates born abstinent was estimated at over $100,000 in hospital costs alone.

CONCLUSION:
Outpatient therapeutic substitution with oral buprenorphine to obtain abstinence is possible in pregnant patients and results in significant cost savings. Ongoing efforts with more data are needed to confirm our findings and explore methods for enhanced success in obtaining abstinence.
Does Comparison of Local Cesarean Rates Influence Where Women Deliver? A Randomized Controlled Trial [21K]
Authors: Gourevitch Rebecca , Mehrotra Ateev , Galvin Grace , Plough Avery , Shah Neel T. 
Published: April 2018

INTRODUCTION:
Few women search publicly available data on hospital cesarean rates when selecting a hospital for childbirth. We assess whether providing women with this data in Ovia Health, a popular mobile application suite, influences their selection of obstetric hospital.

METHODS:
We recruited and randomized 18,293 Ovia Health users who were trying to conceive or were in the first trimester of their pregnancy. Women in both groups were given general information about the importance of cesarean delivery rates. Women in the intervention group also saw a one-time, interactive display of data about cesarean rates of hospitals in their area. Participants were then asked to self report their hospital and answer several questions on cesarean delivery rates. The primary outcome was delivering at a hospital with a primary cesarean delivery rate 23.9% or below.

RESULTS:
We found no difference in the proportion of women who selected a hospital with a low cesarean delivery rate between the intervention and control groups (6.8% versus 7.0%, P=.54). Women in the intervention group were more likely to report that hospitals in their community have different cesarean delivery rates (66.9% versus 55.9%, P<.001), and that they looked at hospital cesarean delivery rates before selecting their provider (44.5% versus 33.9%, P<.001).

CONCLUSION:
Facilitating comparison of hospital cesarean rates improved women's understanding of the rates of hospitals in their community, but did not motivate women to select hospitals with lower cesarean delivery rates. Future efforts should facilitate more sustained exposure and availability of their data.
Whole Genome Sequencing Coverage & Quality at Prenatal Carrier Screening Loci: An Analysis of 15,496 gnomAD Genomes [23K]
Authors: Scott Erick R. , Birch Ashley , Mclellan Andrew , Housman Laura , Gross Susan Joy , Edelmann Lisa 
Published: April 2018

INTRODUCTION:
Current expanded prenatal carrier screening (EPCS) tests leverage several technologies to analyze genomic regions associated with Mendelian disorders. As whole genome sequencing (WGS) becomes more widely utilized some have speculated WGS could replace current EPCS methods. However, a large-scale technical analysis of WGS coverage and genotype dropout at EPCS loci is, to our knowledge, unpublished.

METHODS:
In order to assess the potential to use Illumina WGS methods for EPCS, we downloaded autosomal data for 15,496 genomes (gnomAD browser). We analyzed read coverage at ∼3,400 EPCS loci and frequency of missing/low-quality genotype calls at ∼1,300 EPCS loci.

RESULTS:
We found that WGS provided an average and median coverage of 32 and 31, respectively, across the ∼3,400 EPCS loci. Coverage predicted to yield <99% accuracy (≤10 reads) was found in an average of 17/15,496 genomes (median 11, range 0–728) across the ∼3,400 loci. Considering each of the ∼1,300 loci with gnomAD genotype calls, we found a missing genotype call in an average of 52/15,496 genomes (range 2–11,529). Simulations using a negative binomial distribution predict WGS coverage ≥65X is needed to achieve 99.99% adequate coverage (≥20X) across all genotypes.

CONCLUSION:
This investigation demonstrates that the methods used to generate gnomAD WGS data would provide missing genotype calls that fail to meet clinical standards for a maximum of ∼74% of analyzed genomes; 6 loci had missing genotype calls in more than 500 genomes. Targeted EPCS panels or Sanger confirmation would be required to supplement these WGS results.
Providing Breastmilk to Infants in the NICU: Factors Associated With Lack of Breastfeeding [27K]
Authors: Brown Brooke , Thompson Amy , DeFranco Emily 
Published: April 2018

INTRODUCTION:
This study aims to identify factors influencing breastfeeding non-initiation among NICU infants, compared to non-NICU infants, and inform tailored educational/support interventions.

METHODS:
We performed a population-based, retrospective cohort study of singleton live births using Ohio birth certificates between 2006 and 2015. Univariate analyses assessed the association between NICU breastfeeding non-initiation and predictors relating to the mother, neonate, and delivery events. A multivariate logistic regression model evaluated highly significant predictors, adjusting for socioeconomic, demographic, and neonatal covariates.

RESULTS:
Of 76,855 live births, 5.83% reported NICU admission, 39.4% of which reported non-initiation of breastfeeding, compared with 31.5% of newborn nursery infants (P<.001). Among NICU infants, congenital anomalies and abnormal newborn conditions were the most significant risk factor for non-initiation of breastfeeding, while gastroschisis, low birth weight and very low birth weight were protective for breastfeeding initiation. The most significant maternal risk factors for non-initiation included: smoking during pregnancy (RR 1.91 [95% CI 1.82–2.02]), multiparity (RR 1.72 [95% CI 1.64–1.79]), unmarried (RR 1.68 [95% CI 1.60–1.77]), Medicaid recipient (RR 1.51 [95% CI 1.44–1.58]), no high school diploma (RR 1.48 [95% CI 1.40–1.57]), ≤5 prenatal visits (RR 1.41 [95% CI 1.34–1.49]), age <20 years (RR 1.30 [95% CI 1.21–1.40]), and BMI ≥40.0 (RR 1.26 [95% CI 1.16–1.37]).

CONCLUSION:
Socioeconomically disadvantaged mothers and mothers who smoke are the least likely to initiate breastfeeding for their NICU infants. Maternal-targeted, NICU breastfeeding intervention efforts present an opportunity to reduce infant deaths and improve outcomes.
Nitrous Oxide Versus Epidural for Pain Management During Labor and Delivery [32K]
Authors: Hirschmann-Levy Kate , Pan Stephanie , Cole David 
Published: April 2018

INTRODUCTION:
Expansion of analgesic options is a strong interest of obstetric providers and patients. Epidural leaves women bed-bound; hence, many women desire a less-extreme option, like nitrous oxide (N2O). This study's purpose was to directly compare and determine whether patients preferred N2O to epidural during labor and delivery.

METHODS:
This IRB-approved prospective study included women who gave birth at Mount Sinai West's Labor and Delivery Unit between January 2017 and March 2017. All women who started their labor course using either N2O or epidural, and did not deliver by cesarean section, were asked to complete an anonymous questionnaire after delivery and before discharge. The questionnaire explored subjective experience with analgesia, using yes-no or 1–10 scale answers.

RESULTS:
47 women were included; 29 received epidural as their initial analgesia, while 18 started with N2O. There were no demographic differences between these two groups. Women in the epidural group experienced significantly less pain (3 [2–5] versus 8 [7–9], P<.001); were more likely to complete their delivery using their first analgesic method (29/29 [100%] versus 5/18 [27.8%], P<.001); were more satisfied with their labor and delivery experience (9 [8–10] versus 6 [4–9], P=.002) and stated they were more likely to use their pain relief method again (27/29 [93%] versus 11/18 [61%], P=.018).

CONCLUSION:
This is the first direct comparison of epidural and nitrous oxide. There was a clear preference for epidural. However, responses from women desiring a “natural” birth should be identified and compared. Further research is also needed to study nitrous oxide as a bridge for pain control before receiving an epidural.
Incidence and Predictors of Mortality in Gastroschisis: A Population-Based Study of 4,803 Cases in the United States [35K]
Authors: Brebner Alison , Czuzoj-Shulman Nicholas , Abenhaim Haim Arie 
Published: April 2018

INTRODUCTION:
Gastroschisis is a rare congenital anomaly consisting of a full-thickness abdominal wall defect, with survival normally exceeding 90%. Few large-scale studies have examined the predictors of mortality for these infants. Our objective was to use a large database to determine predictors of mortality in gastroschisis, its incidence and mortality rate over time.

METHODS:
Using the “Period linked Birth-Infant Death” database (CDC) from 2009 to 2013, we collected all infants coded as having gastroschisis. Using multivariable linear regression for various maternal and infant characteristics, we calculated predictors of mortality. We also determined the incidence, death rate and age of death for our cohort.

RESULTS:
There were 4,803 cases of gastroschisis, with 287 deaths. The incidence of gastroschisis increased from 2.04 to 2.49/10,000 births. The rate of death stayed constant around 5.9%. 38.1% of these infants died on day 0 of life. Statistically significant predictors of mortality were paying out of pocket for healthcare, maternal obesity, pre-pregnancy diabetes, birth weight <2,500 g, gestational age <34 weeks and the presence of an additional congenital anomaly (46.2% mortality, OR 13.91).

CONCLUSION:
The incidence of gastroschisis in the United States increased, yet mortality rate remained stable. Mothers with DM1 or 2 should be counselled on the significantly higher risk of mortality, and be encouraged to diligently control their glycemias. The infants born preterm <34 weeks, or with birth weights <2,500 g were at the highest risk. The presence of an additional congenital anomaly is an important prognostic factor, with a high associated mortality. This information can be used in prenatal counselling.
Depression Screening: A “Systems Thinking” Approach to Address Health Disparities in Ob/Gyn Practice [5L]
Authors: Mirhosseini Pegah , Wohlmuth Cinna , Hayes-Bautista Teodocia 
Published: April 2018

INTRODUCTION:
Ob/Gyn patient populations can face many risk factors for depression: lack of social support; history of substance use; poverty; and low educational attainment. If left unaddressed, depression can impact quality of life. This study helps to provide a baseline of knowledge about the implementation of a screening tool, the PHQ-9.

METHODS:
The quality improvement methodology of Plan-Do-Study-Act (PDSA) was used to redesign the clinical microsystem to have an onsite licensed clinical social worker (LCSW), and include a depression screening tool, PHQ-9, to help clinicians and patients assess for symptoms of depression.

RESULTS:
In a 7-month period, 1,673 women were offered a PHQ-9 screen: 68% scored minimal depression; 31% scored mild to severe depression; and 1% declined to participate. Of the 516 women whose score identified mild to severe depression, only 24% (124) of these completed a follow up PHQ-9 screen. Of these 124 women, only 29% had an improvement in their follow up scores, while 46% had no change in their follow up scores. By comparison, of the 1,136 women whose score identified minimal depression, only 15% (166) completed a follow up PHQ-9. Of these 166 women, 79% had no change in their scores, and 14% scored an increased in depression.

CONCLUSION:
These results indicate that while the on-site availability of a LCSW and the use of a PHQ-9 screening tool can help clinicians to assess for depression and monitor improvement, a more robust system is needed to address disparities in mental health care.
Antepartum Vaccination Rates After Initiation of Electronic Medical Record Reminders [8L]
Authors: Keepers Katie , Reddy Madhuri , Satterwhite Catherine , Fitzgerald Sharon 
Published: April 2018

INTRODUCTION:
Tetanus, Diphtheria and acellular Pertussis (Tdap) vaccination is recommended by the CDC between 27 and 36 weeks gestation in order to maximize maternal antibody response and passive antibody transfer to the infant. This study was developed as a quality improvement project for increasing vaccination rates in our university-based clinic.

METHODS:
We developed a best practice advisory alert in the electronic medical record that was implemented September 8, 2016. This alert prompts providers to order the Tdap vaccine or document previous vaccination. It is triggered during clinic visits between 27 and 36 weeks gestation. A chart review was completed for all deliveries at our hospital during a 3 month period prior to implementation and 3 month period post-implementation. A χ2 test was completed to assess differences in Tdap uptake pre- and post-implementation. A Breslow-Day test was completed to identify any differences in uptake by age, parity, and time after initiation.

RESULTS:
A total of 531 pre-implementation and 574 post-implementation charts were reviewed and included in the analysis. The rates of appropriately timed Tdap vaccinations was significantly higher post-implementation than pre-implementation (60.28% versus 39.72% P<.0001). This change was most noticeable in the first month after implementation (P=.0123).

CONCLUSION:
Use of a pop-up reminder in the electronic medical record increased Tdap vaccination rates among women during their third trimester. Although with maximum vaccination rates less than 70% at the peak, more can be done to educate providers and patients about the importance of antepartum vaccination.
Breaking Bad News to Patients With Breast Cancer—The Benefits of Hope and Optimism [9L]
Authors: Vakada Saritha , Bachmann Gloria A. , Lu Chi-Wei 
Published: April 2018

INTRODUCTION:
Receiving a diagnosis of breast cancer can be devastating. In the interest of avoiding false hope, health care professionals may break the news without imparting a sense of optimism. Studies reflect that optimistic patients may have a greater sense of well-being and employ useful coping skills. Incorporating strategies for optimism could be an important psychological intervention.

METHODS:
A literature review using standard search engines was utilized which involved a total of 7 scholarly articles, journals and websites devoted to breast cancer, hope and optimism.

RESULTS:
Studies reflected in multiple articles suggested that optimistic breast cancer patients may be less susceptible to depression and have a greater sense of well-being. Optimists often employ coping traits such as self-transcendence (finding meaning), mindfulness (mitigating negative thinking and worry) resilience (imparting strength in adversity), positive reframing, humor, and spirituality. These traits may help breast cancer patients improve their ability to adjust emotionally and psychologically. Studies show optimism may also help reduce stress and avoid or lessen depressive symptoms, may foster better mental and emotional adjustment, and promote feelings of physical attractiveness. Installing interventions that promote optimism with auxiliary coping skills would be a practical way to empower patients with coping tools requiring no additional pharmacological resources.

CONCLUSION:
Optimism can be acquired through behavioral modifications. Hospitals and clinics should consider developing optimism intervention strategies and begin teaching them to patients at the point of diagnosis. This could help empower women to immediately begin employing positive coping skills.