bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multimedia Versus Traditional Informed Consent for Cesarean Delivery: A Randomized Controlled Trial [2C]
Authors: Ratan Rini B. , Rupley Devon M. , Palmerola Katherine , Smith Devin D. , Sealy Petra 
Published: April 2018

INTRODUCTION:
Informed consent is an integral preamble to every surgery, traditionally consisting of a conversation between physician and patient reviewing risks, benefits, and alternatives to the proposed procedure. However, patients may absorb only a fraction of verbally communicated information. This study evaluated the use of a multimedia tool to improve pre-surgical consent for cesarean delivery.

METHODS:
English-speaking patients undergoing scheduled cesarean delivery at a single university hospital were eligible to participate. Patients were randomized to traditional verbal consent or to a multimedia tool for pre-surgical consent. Patients completed preoperative and postoperative surveys assessing subjective comprehension, satisfaction, and anxiety.

RESULTS:
Of 100 total study participants, 50 were randomized to receive verbal consent and 50 were randomized to multimedia consent. Demographic data including age, ethnicity, education, and prior surgery were similar in both cohorts. Pre- and post-surgical assessment of understanding, satisfaction and anxiety did not differ significantly between groups. However, 50% of patients who received multimedia consent said they would have preferred a video tool in prior surgeries versus 20% in the verbal cohort who wished they had viewed a video before undergoing previous surgeries (p=0.003). When analysis was limited to patients undergoing first cesarean delivery, patients receiving video consent reported lower anxiety for future cesarean sections (71.2 ± 31.1 on 100-point scale) versus verbal consent patients (85.8 ± 16.1), although this difference did not reach statistical significance (p=0.092).

CONCLUSION:
Our findings suggest that multimedia educational tools may be a valuable complement to traditional verbal conversations in the pre-surgical informed consent process.
Graduate Medical Education Salary Gap: Is Military Service an Equalizing Force? [4C]
Authors: Lutgendorf Monica , Thagard Andrew , Foglia Lisa M. 
Published: April 2018

INTRODUCTION:
Disparities exist between resident salaries and other professionals. We compared salaries to determine if military pay equalizes financial disparities in civilian graduate medical education training.

METHODS:
Using aggregate salary data, we compared military versus civilian salaries for residents and staff physicians in OB/GYN. Military pay was from 2017 Defense Finance and Accounting Service (DFAS) tables, including: base pay, housing/subsistence allowances, incentive and board certification pay. Military residents were calculated for O-3, and staff salaries the average of O-4 and O-5. Civilian salaries were from Medscape 2016 Residents Salary & Debt Report, Medical Group Management Association (MGMA) 2017 Provider Compensation Report for private practice, and from 2015-2016 Association of American Medical Colleges (AAMC) Faculty Salary Report for academic providers, using the rank of Assistant Professor.

RESULTS:
The GME salary gap was positive, with mean civilian OB/GYN residents $55,000, compared to military residents $91,287, +66% difference. For staff, the salary gap is negative, with mean private practice $368,135 and mean academic $277,000 compared to military $163,099, -56% and -42% respectively. For subspecialists in OB/GYN, the military is $168,099 compared to private practice UROGYN $422,413 (-$60%); private practice REI $427,667 (-60%) academic REI $392,000 (-57%); private practice GYN/ONC $486,118 (-65%) academic GYN/ONC $323,600 (-50%); private practice MFM $536,279 (-69%) academic MFM $339,700 (-52%).

CONCLUSION:
A salary gap exists in the military, shifting from positive in residency to negative for staff. The gap is smaller for academic faculty compared to private practice. Actual salaries vary based on multi-year bonuses and scholarship programs that decrease debt.
One Way Video Interviewing As A Method to Augment the Residency Application [5C]
Authors: Breitkopf Daniel , Hopkins Matthew R. , Camp Christopher L. , Occhino John A. , Weaver Amy , Turner Norman S. 
Published: April 2018

INTRODUCTION:
Despite the increase in residency applications, little change in the information available for review prior to a face-to-face interview has occurred. Asynchronous or one way video interviews (OWVI) may offer a way to collect additional data on applicants. Our objective was to assess the feasibility and acceptability of OWVI and to correlate OWVI performance with in-person interview scores.

METHODS:
Characteristics of successful residents were identified and OWVI questions were developed using medical student volunteers. Candidates who presented for in-person interviews during the 2016-17 season for OB/GYN (n= 45) and Orthopedic Surgery (n=98) were invited to participate in OWVI with 3 questions and a maximum of 3 minutes per question. Videos were reviewed and scored independently by 2 reviewers from the respective departments using a standardized 5-point scale.

RESULTS:
Forty-six (47%) Orthopedic and eleven (24%) OB/GYN applicants completed OWVI. The interviewer’s scores of OWVI were within one point of one another 84% of the time. High OWVI scores were correlated with higher in-person interview scores (r=0.26) and higher rank list placement (r=0.33). Sixty-two percent of the applicants were satisfied with the OWVI process. Most respondents wanted additional OWVI questions that would allow them to explain why they wanted to apply to a particular program.

CONCLUSION:
Asynchronous interviews enabled reviewers to differentiate applicants and their scores correlated with rank list placement and in person interview scores. The process was viewed by participants as a way to humanize their application and this may have potential to help screen applicants for residency.
Automated Residency Scheduling: Impacts on Resident Satisfaction and Wellness [6C]
Authors: Hollenbach Stefanie J. , Harrington Amy , Duecy Erin 
Published: April 2018

INTRODUCTION:
Schedule generation for resident coverage is a complex undertaking. While most programs continue to use manual scheduling, large corporations have turned to operations research for algorithms that automate generation of significant portions of their employees' schedules. The goal of this study was to quantify the impact on residents of using algorithm-based schedule generation.

METHODS:
Prospective cohort study of current Ob-Gyn residents at University of Rochester before and after implementation of automated schedule generation with additional perspective data from the past decade of prior administrative chiefs via electronic survey sent by email. Descriptive statistics were performed on prior administrative chief perspectives; paired t-tests of unequal variance were performed for each resident questionnaire parameter of 5-point Likert scale responses.

RESULTS:
Of the 22 eligible residents, 21(95%) completed the pre-transition survey and 17(77%) completed the post-transition survey. Prior administrative chiefs (60% of prior decade) confirmed that schedule generation is time consuming (2-100 hours) with modifications required on a weekly to monthly basis. Following implementation of automated scheduling, there was an increase in resident satisfaction with initial (3.24 to 4.29, p=0.0017) and accommodation (2.67 to 3.65, p=0.01) schedule requests as well as improved satisfaction with transparency in schedule preparation (2.76 to 3.82, p=0.01) and perceived equitable accommodations (3.1 to 4.12, p=0.01). There was not a statistically significant impact on indicators of resident wellness.

CONCLUSION:
Implementation of automated scheduling software for this Ob-Gyn residency improved resident satisfaction. Regardless of scheduling approach, preparation of resident schedules is complex and provides ample opportunity for technology-based quality improvement.
Comparison of Thiel-Embalmed and Plastic Models for Teaching Female Pelvic Exam Technique [10C]
Authors: Chatman Alexandra I. , Shelton Kathryn M. , Becker Robert M. , Campbell Aaron D. , Gozmao Liane P. , Abercrombie Caroline 
Published: April 2018

INTRODUCTION:
Medical students at ETSU Quillen College of Medicine currently receive pre-clerkship pelvic exam training through low fidelity simulation (LFS) pelvic models. These models do not allow students to gain familiarity with all aspects of the pelvic exam before clinical experiences. ETSU has adopted a soft embalming technique, the Thiel method, which allows for better soft tissue tactile preservation and joint mobility. This pilot study evaluated the utility of using the Thiel-embalmed donors compared to the current LFS models in teaching pelvic exam technique.

METHODS:
A randomized experimental study with fourteen first year medical students was conducted. Students were divided into the experimental group (Thiel-embalmed donor) and control group (LFS model). All students completed pre- and post-surveys assessing confidence, transference to clinical practice, and realism.

RESULTS:
The study suggests that students accepted both models as pelvic exam teaching platforms. Examining data from the groups’ post-surveys indicated that students using the Thiel-embalmed donor reported a high level of confidence with their skills, resolved the experience was transferrable to patient care, and determined that the Thiel donor was a realistic representation of the pelvic exam. The plastic model had less positive reviews on transference to patient care, being realistic, and instilling confidence in new skills.

CONCLUSION:
Due to the small sample size of this study, the data collected do not have the power to detect statistical significance in differences between student reception of both models. While more data need to be collected to determine statistical significance, this instruction method is a promising development in medical education.
Delivery of Nulliparous Women at Term with Vaginismus [15C]
Authors: Peleg David , Curelaru Shiri , Geva Gil , Warsof Steven L. , Ben Shachar Inbar 
Published: April 2018

INTRODUCTION:
To compare the mode of delivery of nulliparous women with vaginismus at term to those without vaginismus.

METHODS:
This was a retrospective case-control study. Nulliparous women ≥37 weeks presenting in labor with a diagnosis of vaginismus, defined as chronic recurring difficulty for a woman to allow vaginal penetration, were included. The control group consisted of the next two nulliparous women delivering at term. Delivery data were compared between the groups.

RESULTS:
26 women with vaginismus were compared to 52 controls. Demographics were similar between the groups. The cesarean delivery rate was significantly higher in the vaginismus group (38% vs. 13%, p=0.019). Maternal request was the major contributing factor (19% vs. 0%, p=0.002). Four women in the vaginismus group required perineal suturing using IV sedation or general anesthesia compared to none in the control group.

CONCLUSION:
Nulliparous women with vaginismus have a significantly higher cesarean delivery rate. Maternal request is a major contributing factor rather than standard obstetrical indications. Perineal repair following vaginal delivery often requires iv sedation in the operating room.
Are CenteringPregnancy Patients More Likely Than Traditional Care Patients to Receive Influenza Vaccination? [17C]
Authors: Prieto Autumn , Roussos-Ross Dikea , Goodin Amie , Watson Amelia K. 
Published: April 2018

INTRODUCTION:
CenteringPregnancy (CP) patients receive approximately 20 hours of prenatal care compared to 3 hours in Traditional Care (TC). Due to the social structure and additional time for discussion, we investigated whether CP patients were more likely to receive influenza vaccination compared to TC patients.

METHODS:
A retrospective chart review was conducted comparing all CP patients to a matched cohort of TC patients seen at UF Health between March 2015 and March 2017. Chi square analysis was performed, with a priori significance set at 0.05. Logistic regression models estimated the relationship between the outcome and CP versus TC participation, controlling for patient characteristics.

RESULTS:
A total of 153 CP patients and 259 TC patients were included in the study. CP patients received significantly greater influenza vaccinations (62.00% vs. 40.80%; p<0.001) than traditional care patients. After controlling for patient characteristics, CP patients were 1.84 times more likely to receive influenza vaccinations than TC patients (95% CI: 1.15-2.93).

CONCLUSION:
Patients enrolled in CP are more likely to accept influenza vaccination compared to patients in TC. It is possible that the increased discussion within the group setting, and the knowledge that peers are accepting the vaccination, may motivate patients to receive the vaccination. Further investigation would be necessary to determine if these findings are reproducible.
A Clinical Evaluation of the 2014 ACOG/SMFM Obstetric Care Consensus Statement [24C]
Authors: White Andrew , Chambers Charis , Ertel Michelle , Gennaro Taylor , Friedman Alexander , Eichelberger Kacey 
Published: April 2018

INTRODUCTION:
It is unknown whether primary cesarean deliveries (CDs) performed in compliance with the 2014 ACOG/SMFM Obstetric Care Consensus Statement (“guideline-compliant”) are associated with a modified risk of maternal and neonatal morbidity, when compared to primary CDs performed outside the new guidelines (“guideline-noncompliant”). Our primary objective was to determine if a guideline-compliant primary CD is associated with a modified risk for maternal or neonatal morbidity, when compared to guideline-noncompliant primary CD.

METHODS:
Retrospective cohort study of women undergoing primary CD at the state’s largest maternity hospital in 2015. Maternal, neonatal, and labor course variables were collected via review of electronic clinic records and labor notes. Univariate and logistic regression analyses were performed, where appropriate.

RESULTS:
827 women delivered via primary CDs during the study period, of which 288 (34.8%) were guideline-compliant, 215 (26.0%) guideline-noncompliant, and 324 (39.2%) guideline-not addressed. Women undergoing guideline-compliant primary CD were no more likely to experience an adverse maternal outcome compared to guideline-noncompliant and guideline-not addressed primary CDs, in adjusted analysis (AOR 1.10, 95% CI .58-2.07; AOR 1.20, 95% CI .67-2.14 respectively). However, guideline not-addressed primary CDs were associated with a significantly increased risk of any adverse maternal or neonatal outcomes, when compared to guideline-compliant primary CDs (AOR 4.16, 95% CI 2.78-6.23).

CONCLUSION:
Guideline-compliant primary CDs were not associated with increased risk of maternal or neonatal morbidity when compared to guideline-noncompliant primary CDs. Compliance with the 2014 Obstetric Care Consensus Statement may be associated with a decreased primary CD rate without an increased risk of adverse outcomes.
Adequacy of Prenatal Care in Young Pregnant Adolescents: A Retrospective Cohort Study [26C]
Authors: De Simone Avina P. , Arie Abenhaim Haim , Czuzoj-Shulman Nicholas , Spence Andrea 
Published: April 2018

INTRODUCTION:
Adolescents often receive suboptimal prenatal care, which may account for increased adverse outcomes. We determined the distribution of inappropriate prenatal care by maternal age, examined the temporal trend of inappropriate care among adolescents ages 12-15 and their effects on neonatal outcomes.

METHODS:
Using the CDC Period Linked Birth/Infant Death File, we conducted a retrospective cohort study of adolescents ages 12-15 who delivered between 2011-2015. Adequacy of care was measured using the R-G INDEX. Linear regression analysis was used to measure adequacy of care and unconditional multivariate logistic regression was used to examine its effects on neonatal outcomes.

RESULTS:
We observed decreasing rates of inappropriate care with rising maternal age. Among 63,484 adolescents ages 12-15, 14,845 (23.38%) received inappropriate care with rates rising significantly during the study period. Inappropriate care was most common among mothers ages 12-15 who were of Black (31.74%) or Hispanic ethnicity (26.66%), those with more than one prior birth (two prior births 30.30%), those presenting to their first prenatal visit at >7 months gestation (97.51%), and those with higher BMIs (BMI 25-29.9 28.16%, BMI 35-39.9 29.69%, BMI 40+ 33.78%). Neonates born to adolescents ages 12-15 and who received inappropriate prenatal care were significantly more likely to involve IUGR (7.58%, OR1.40, 95% CI (1.30-1.51)), infant deaths (1.33%, OR 1.35, 95% CI (1.15-1.58)) and NICU admissions (9.84%, OR 1.27, 95% CI (1.19-1.35)).

CONCLUSION:
Inappropriate care decreased with rising maternal age. Adolescents ages 12-15 experienced increasing rates of inappropriate care from 2011-2015 and were associated with certain demographics and poorer neonatal outcomes.
Adequacy of Prenatal Care Between Hospital-Based, Prepaid, Bundled Program and Traditional Medicaid [28C]
Authors: Duncan Erin , Narvaez Jennifer , Topel Matthew , Haddad Lisa , Loucks Tammy , Ellis Jane 
Published: April 2018

INTRODUCTION:
Access to adequate prenatal care (PNC) is a goal of HealthyPeople 2020. However, not all pregnancies in the U.S. are guaranteed this benefit, particularly in States that have not expanded Medicaid or have high concentrations of pregnancies in undocumented women. To address this gap, our institution created a prepaid, bundled PNC package (Grady Healthy Baby-GHB) for women who did not qualify for public insurance. Prenatal visits and two ultrasounds were included. Our goal was to determine whether GHB participants received adequate PNC relative to Medicaid.

METHODS:
Viable singleton deliveries from 2011-2014 were eligible. A randomly selected, retrospective cohort of 100 GHB and 100 Medicaid deliveries was created. Demographics, pregnancy information, number of prenatal visits and ultrasounds were abstracted and pregnancy risk status and adequacy of PNC determined. Descriptive statistics and logistic regression models were used to characterize groups and examine adequacy of PNC.

RESULTS:
GHB participants were older, more likely to be Hispanic and less likely to be Black compared to Medicaid participants (P<0.001 for all). Among women with a low risk pregnancy, GHB participants were more likely to have adequate PNC compared to Medicaid patients (P<0.001). Significance remained after adjustment (aOR 3.75, P=0.015). In high risk pregnancies, there was no difference in adequacy of PNC.

CONCLUSION:
Women with low risk pregnancies enrolled in a prepaid, bundled PNC package were more likely to receive adequate care than women with Medicaid. This study has implications for all pregnancies that begin as uninsured, especially in the current political climate.
Acceptance of Vaccination in Centering Pregnancy in an Inner-City Community Teaching Hospital [29C]
Authors: Jaramillo Helen , Casquero-Leon Jorge , Abduallah Amirah , Inglis Steven , Magloire Tamara , Khalil Susan 
Published: April 2018

INTRODUCTION:
Centeringpregnancy® models, or group pregnancy can help increase compliance with visits, and improve key quality metrics. Vaccination with Tdap, is an important component in preventative care during pregnancy. The goal of this study is to assess this in centerpregnancy® groups, in an inner city community teaching hospital.

METHODS:
A retrospective chart review was performed in a prospectively maintained database of centeringpregnancy® patients, that received care in an inner-city community teaching hospital’s outpatient setting. Charts were reviewed for vaccination compliance with Tdap.

RESULTS:
A total of 146 participants were included. Most were compliant with their prenatal care sessions, 2.7% missed 3 or more visits. The acceptance rate during pregnancy, when asked if they would agree to receive Tdap vaccination was 95%. However, at the time of administration, 4 declined. The administration of the vaccine to the group was 87%, with most receiving it in the third trimester (92.3%). The remainder agreed to receive the vaccination in the postpartum unit.

CONCLUSION:
Further studies are needed to investigate reasons for non-acceptance of vaccination during pregnancy in diverse patient settings. The utility of group pregnancy models confers an opportunity for health education and peer-modeling.
A Survey of Women and Their Providers Regarding Gestational Weight Gain Across the United States [31C]
Authors: Power Michael L. , Gaspar-Oishi Maria , Gibson Kelly S. , Rhoades Courtney , Turrentine Mark , Yamamura Yasuko , Mackeen A. Dhanya 
Published: April 2018

INTRODUCTION:
Assess patient and provider knowledge and opinions about gestational weight gain (GWG) particularly in relation to the Institute of Medicine (IOM) guidance with respect to maternal body mass index (BMI).

METHODS:
Questionnaires were distributed by medical centers across the United States to patients (8 sites) and providers (7 sites). Data on maternal BMI and GWG was collected at all sites.

RESULTS:
1,157 women returned questionnaires (1,820 maximum possible). A majority at all sites reported a provider discussed their expected GWG with them. Close to half reported that a provider had discussed potential harms from inappropriate GWG. Most of the women (71.2%) considered their obstetrician to be a helpful resource for GWG advice. Most providers (87.5%) reported they were aware of the IOM guidelines. As many providers disagreed (18.8%) as agreed (20.8%) that they were successful at helping their patients gain an appropriate amount of weight during pregnancy (58.3% were neutral). Physician self-reported confidence was associated with their opinions on whether they could help their patients avoid excessive GWG. The most common outcome at all sites was GWG above the IOM recommendations. Overweight and obese women were more likely to gain above recommendations. Providers underestimated the proportion of their patients that gained below recommendations (8.5% versus 18.9%).

CONCLUSION:
Providers are aware of the dangers of excessive GWG and are counseling patients. Providers appear more cognizant of excessive GWG and underestimate the proportion that may have inadequate GWG. Most women are not achieving an appropriate GWG, especially overweight and obese women.