bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of Chronic Hypertension on Treatment of Urgent Hypertension in Patients With Severe Pre-Eclampsia [10F]
Authors: Litman Ethan , Cui Yiwen , Feustel Paul , Bringley Johanna , Rijhsinghani Asha 
Published: May 2019

INTRODUCTION:
We studied the impact of pre-existing hypertension on the management of severe hypertension in patients diagnosed with preeclampsia.

METHODS:
We analyzed 227 antepartum patients who developed severe blood pressures (systolic >=160 mmHg and/or diastolic >=110 mmHg) requiring IV labetalol over a 2-year period. Patients were grouped by diagnosis of chronic hypertension with superimposed preeclampsia with severe features (CHTN, n=82) versus preeclampsia with severe features (preE, n=142). Electronic records were reviewed for anthropomorphic data. Blood pressure was extracted every 15 minutes starting after the first dose of labetalol. We performed a repeated-measures analysis of variance for statistical modeling, controlling for patient-patient variance.

RESULTS:
The baseline systolic (SBP) and mean arterial pressure (MAP) did not differ significantly between CHTN and preE groups (SBP of 164 vs. 167 mmHg, p=0.2; MAP of 119 vs. 121 mmHg, p=0.2). ANOVA revealed a significant effect of time and demonstrated a consistently significant greater SBP decrease per unit of time in preE group compared to CHTN (p<0.002, Model R2=70%). Differences in MAP between the two groups remained constant post-treatment and approached significance (p=0.052, Model R2=67%). The greatest difference in SBP between the two groups was observed 30 and 60 min post-treatment (8 and 9 mmHg, respectively, p<0.002).

CONCLUSION:
Patients with pre-existing hypertension achieved a smaller reduction in SBP and MAP compared to those without, when given the same treatment for acutely severe blood pressure. This suggests that the former group of patients may benefit from alternative drug regimens to achieve adequate blood pressure control.
Reasons for Unplanned 30-Day Readmission After Total Laparoscopic Hysterectomy: A Single Institution Study [3D]
Authors: Le Chi , Elsamadicy Emad A. , Lee Jaclyn , Brown Kelsei 
Published: May 2019

INTRODUCTION:
There is a scarcity of literature regarding surgical outcomes after total laparoscopic hysterectomy (TLH). We investigated patient risk and reasons associated with readmission within 30 days after TLH.

METHODS:
Medical records of 168 consecutive patients who underwent TLH at a major academic center between 2010 and 2012 were reviewed. Robotic hysterectomies were excluded. Patient's age, BMI, and co-morbidities before surgery were collected. Timing, reasons, and management of readmitted patients were evaluated.

RESULTS:
Among 168 patients reviewed, 8.9% of patients were readmitted within 30 days (95% CI: 5.5-14.2%). Intraoperative variables revealed the average length of operation (151 ± 52 minutes), average estimated blood loss (90±107 ml), and urine output (350±245 ml). No intraoperative transfusions were performed. Over half (60%) of patients were obese (BMI>30), and associated co-morbidities included anemia (33.3%), depression (26.7%), anxiety (26.7%), hypertension (20.0%), and diabetes (13.3%). The average time until return were 9.0 ± 6.0 days with the main location of readmission through the emergency department (93.3%). Primary chief complaints were pain (86.7%), nausea (33.3%), and vomiting (26.7%). Shortness of breath (13.3%), UTI (13.3%), Fever (13.3%), and bleeding (13.3%) were reported. At readmission, 33% of patients were only observed, while 6.7% received antibiotics, and 73.3% receiving additional pain control.

CONCLUSION:
Our study showed that readmission after TLH tend to occur after soon after discharge. Obesity and pain were the most frequent co-morbidity and complaint respectively, requiring readmission within 30 days. Future studies are necessary to identify patients who are at greater risk of readmission to improve surgical outcomes.
Improving Preoperative Administration of Azithromycin in Indicated Cesarean Sections [22L]
Authors: Handley Katelyn Foster , Nakahara Angela , Gillispie Veronica 
Published: May 2019

INTRODUCTION:
To use quality improvement tools to improve preoperative administration of azithromycin in unscheduled cesarean sections (C/S).

METHODS:
We determined baseline adherence to the guideline by chart review from 11/01/2017 to 02/11/2018. Unscheduled C/S was defined as a C/S after rupture or the onset of labor. This quality improvement initiative involved three plan-do-study-act (PDSA) cycles over a 2.5 month period including: PDSA#1: modified the timeout prior to cesarean section to include indication for and administration of azithromycin; PDSA#2: updated the L&D admission order set to include a PRN order for azithromycin; PDSA#3: added azithromycin to the Pyxis. We evaluated each intervention by comparing the percentage of patients receiving azithromycin in indicated C/S before and after implementation to determine if the change idea for that PDSA cycle was effective. We also gathered data on prospectively determined data points including emergent status, indication for azithromycin, indication for C/S, and practice type.

RESULTS:
Administration rate increased from 74% to 90% after all interventions (p=0.12). The rate increased after PDSA#1 to 75%, decreased after PDSA#2 to 71%, then finally increased to 90% after PDSA#3. In the subset of nonemergent cesarean sections, the administration rate increased from 75% to 94% (p=0.08). According to indication for azithromycin administration, 82.2% of ruptured patients received azithromycin while only 43.8% of laboring only patients received azithromycin. Administration also differed by indication for cesarean section.

CONCLUSION:
We were successful in increasing the administration of azithromycin in indicated cesarean sections to our goal of 90% compliance.
Predictors of Anticipated Pain During Intrauterine Device Insertion in Adolescents and Young Women [9M]
Authors: Hunter Tegan , Sonalkar Sarita , Schreiber Courtney A. , Perriera Lisa , Sammel Mary , Akers Aletha 
Published: May 2019

INTRODUCTION:
Intrauterine devices (IUDs) are highly effective contraception, but their use in adolescents remains low. Fear of pain during IUD insertion may deter use. Here, we investigate the characteristics associated with anticipated pain with IUD insertion in adolescents and young adult women.

METHODS:
We performed a secondary analysis on a single-blind randomized trial of 95 adolescents and young adult women undergoing insertion of a 13.5 mg levonorgestrel IUD while receiving either a lidocaine or sham paracervical block. We ascertained visual analog pain scores before and at 6 time points during the procedure. We performed linear regression to identify demographic, mood, and sexual/gynecologic history covariates associated with anticipated pain. We used student's t-test to test for associations between anticipated pain and perceived pain (p<0.0083 using a Bonferroni adjustment).

RESULTS:
Women with anticipated pain scores above the median have significantly higher perceived pain at 5 of 6 timepoints (p<0.008). Only Black race significantly predicted anticipated pain. Black participants (n=34) had the highest average anticipated pain scores (63.6 mm) compared to White participants (n=45; 47.0 mm) and participants of all other races (n=16; 55.0 mm, p=0.014). Black participants had an adjusted mean anticipated pain score 15.1 mm higher than for white participants (p=0.017).

CONCLUSION:
Despite recent increased IUD use, Black women are less likely than women of other races to select IUDs as their method of contraception. We identify that this population experiences greater anticipated pain with IUD insertion and may benefit from additional counseling and other efforts to reduce this barrier to IUD use.
Risk of Chronic Opioid Use Among Women With Endometriosis [16M]
Authors: Chiuve Stephanie E. , Kilpatrick Ryan D. , Petruski-Ivleva Natalia , Wegrzyn Lani R. , Snabes Michael C. , Bateman Brian T. 
Published: May 2019

INTRODUCTION:
Women with endometriosis may be prescribed opioids for management of endometriosis-related pain symptoms or in the context of surgical procedures. Once exposed, these women may be vulnerable to chronic opioid use given their comorbidity profile.

METHODS:
Women with an initial claim for endometriosis (N=37,142) and women without (N=2,596,871), aged 18-50, were identified from a US commercial insurance claims database and followed for 2 years. Chronic opioid use was defined as ≥10 fills or ≥-120 days covered over 1 year. Regression models estimated the association between endometriosis and chronic opioid use, and sequelae of chronic use among women with endometriosis.

RESULTS:
The 2-year risk of chronic opioid use was 4.4% in women with endometriosis and 1.1% in women without. The relative risk (RR) for chronic opioid use in women with endometriosis v. without was 2.11 (95% CI 2.00-2.23) controlling for demographics, pain, mental health comorbidities, substance abuse, use of benzodiazepine, stimulants, antipsychotic medications and prior opioids. Among women with endometriosis, the median dose per fill increased by 50% over 2 years among chronic opioid users and 0% among non-chronic users. Chronic opioid use among women with endometriosis was associated with higher risk of an opioid dependence diagnosis (RR 8.52; 95% CI 6.67-10.9), overdose (RR 3.97; 95% CI 1.90-8.30), altered mental status (RR 2.92; 95% CI 2.16-3.93), falls (RR 2.43; 95% CI 2.02-2.92) and constipation (RR 1.87; 95% CI 1.71-2.05).

CONCLUSION:
Women with endometriosis have a greater risk of chronic opioid use and its sequelae. Physicians should consider the consequences of opioid prescribing for endometriosis-associated pain.
A Comparison of Prenatal Substance Use Screeners That Assess for Illicit Drug Use and Prescription Drug Misuse [22M]
Authors: Coleman-Cowger Victoria H. , Oga Emmanuel A. , Peters Erica , Mark Katrina 
Published: May 2019

INTRODUCTION:
Prenatal substance use screening is crucial to identify pregnant women at risk of associated harmful effects. There is no universally recommended substance use screener validated for use with pregnant women.

METHODS:
This cross-sectional study enrolled a convenience sample of 500 pregnant women from two prenatal clinics in Baltimore, Maryland. All participants were administered the 4P's Plus, NIDA Quick Screen/ASSIST and SURP-P, and had biochemical testing of urine and hair at the first research visit. To assess test-retest reliability, screener administrations were repeated one week later via telephone. Sensitivity, specificity, positive predictive value, negative predictive value and test-retest reliability were computed. Results were stratified by age, race, and trimester of pregnancy.

RESULTS:
For the 4Ps Plus, sensitivity = 90.2%, specificity =29.6% and false negative rate (95% CI) = 9.8% (5.9, 15.1). For the NIDA Quick Screen/ASSIST, sensitivity = 79.7%, specificity = 82.8% and false negative rate (95% CI) = 20.3% (14.7, 26.9). For the SURP-P, sensitivity = 92.4%, specificity = 21.8% and false negative rate (95% CI) =7.7% (4.3, 12.5). Test-retest reliability (phi correlation coefficients) was 0.84, 0.77, and 0.79 for the 4P's Plus, NIDA Quick Screen/ASSIST and the SURP-P, respectively. For all screeners, there were differences in diagnostic indices by age and race, but no differences by trimester.

CONCLUSION:
The SURP-P and 4P's Plus had high sensitivity and negative predictive values. A clear recommendation for a clinically useful screening tool for prenatal substance use is crucial to allow for prompt and appropriate follow-up and intervention.
A Comprehensive Analysis of Allele Frequencies From 476,930 Spinal Muscular Atrophy Test Results [23M]
Authors: Evans Matthew , McCarthy Michele , Moore Rebecca , Karbassi Izabela , Alagia Damian Paul , Lacbawan Felicitas 
Published: May 2019

INTRODUCTION:
Spinal muscular atrophy (SMA) is an autosomal recessive neurodegenerative disease caused by homozygous deletion of the SMN1 gene. Disease severity is related to the copy number of the highly homologous, yet functionally insufficient, pseudogene SMN2. SMA has no cure; but prognosis improves if treatment is started early in life, with the most significant gains observed when initiated pre-symptomatically. Delay in genetic confirmation of diagnosis may be a barrier to early treatment, therefore we sought to evaluate our historical SMA testing data.

METHODS:
We performed a blinded review of carrier (n=460,703) and diagnostic (n=16,227) tests submitted over a 15-year period across 4 testing sites in a US population. Allele frequencies of SMN1 and SMN2 were determined for all diagnostic and carrier SMA test results in respect to available patient demographics such as sex and age at the time of testing.

RESULTS:
The observed SMA carrier frequency was 1:53, decreased from the commonly cited rate of 1:35-1:40, but within range of previous studies. In affected individuals, age at time of testing correlate to SMN2 copy number and aligns with a delay in disease presentation with increased SMN2 copies.

CONCLUSION:
Early diagnosis and treatment of SMA is critical in order to maximize the positive impact on patient quality of life and life expectancy. These data suggest a potential delay in genetic diagnosis of SMA and, therefore, would correlate to a lag in treatment course initiation. Broad implementation of newborn screening programs and timely confirmatory testing will likely improve service to the SMA community.
Gender-Affirming Surgeries in Transmasculine People: An Individualized Decision [27M]
Authors: Abern Lauren , Cook Jake , Maguire Karla 
Published: May 2019

INTRODUCTION:
The process of transitioning is a journey unique to each transgender individual. While many wish to obtain various gender-affirming surgeries and face many barriers in that process, some do not desire surgery to transition. The goal of this study is to determine if transmasculine people underwent gender-affirming surgery, reasons for not proceeding with surgery, and barriers experienced.

METHODS:
Transmasculine people ages 18-64 participated in an online survey which included demographics, surgical history, reasons for not obtaining surgery, and barriers to care.

RESULTS:
781 individuals participated. The mean age was 27 (SD 8.6). The majority was white (663, 85%) and had a college degree (344, 44%). 530 had private insurance (68%), and 413 (53%) made less than $24,000/year. 468 (60%) were on hormone therapy. 289 (37%) underwent a form of gender-affirming surgery. 357 (73%) plan to do so in the future. 262 (54%) have not had surgery due to financial reasons, and 112 (23%) as a result of insurance difficulties. 61 (13%) do not plan on having surgery, and 23 (5%) are uncertain. 61 (13%) risk losing family support if proceeding with surgery. If cost was covered, 239 (32%) said they would not proceed with bottom surgery while 242 (32%) were unsure.

CONCLUSION:
The decision to proceed with various gender-affirming surgeries is individualized, with people desiring none, some, or all surgical options. Barriers including insufficient finances and lack of insurance coverage make it difficult for those that desire surgery, despite many having private insurance. This is important to consider when counseling about transition-related care.
Detecting Preeclampsia Using Data From a Pregnancy Mobile App [30M]
Authors: Bradley Danielle , Landau Erin , Wolfberg Adam , Baron Alex 
Published: May 2019

INTRODUCTION:
The objective was to create a predictive model for preeclampsia detection when app users do not report diagnosis or are not yet aware of their diagnosis.

METHODS:
A supervised machine learning algorithm, specifically, a Gradient Boosting Decision Tree algorithm, incorporating data from 77,621 users of a mobile app was used to create a model for the purpose of detecting the presence of preeclampsia.

RESULTS:
Of the total sample used to train the model, 41% had preeclampsia based on patient report of a diagnosis made by their clinician. The model used 385 different features to model the likelihood of currently having preeclampsia, even if disease status was not yet known or if diagnosis had not yet been reported in-app. Self-report data, as well as in-app calculations based on reported data, were used to create the model. The frequency of reported 'daily data' such as, health symptoms (e.g., fatigue and exhaustion, and blood pressure readings), moods, nutrition, and exercise activities were most influential to the model. Personal demographic information including age and BMI (height and weight) also contributed to the mode. The model's positive predictive value was 0.75, with 0.37 sensitivity. With a positive predictive value of 0.65, sensitivity increased to 0.79.

CONCLUSION:
A model used to identify the presence of preeclampsia was most influenced by the frequency of data logging for specific features. This model could prove highly informative for patients, especially those without access to regular healthcare, as the presence of a serious condition could be identified, prompting referral to a healthcare provider.
Patient-Physician Interactions Regarding Dyspareunia With Endometriosis: Online Survey Results [33M]
Authors: Witzeman Kathyrn A. , Flores Oscar Antunez , Renzelli-Cain Roberta , Worly Brett , Schneider Beth 
Published: May 2019

INTRODUCTION:
Dyspareunia is a challenging symptom of endometriosis-related pelvic pain, exacerbated by suboptimal communication between the patient and healthcare professional (HCP). Our aim was to describe patient-HCP communications regarding diagnosis and management of dyspareunia in endometriosis patients.

METHODS:
An IRB-approved 24-question online English-language survey was conducted among women 19 years or older who self-identified as having endometriosis and dyspareunia. Women were asked about their interactions with HCPs about dyspareunia. Participants were recruited via MyEndometriosisTeam (a social network for women with endometriosis); members were invited by e-mail. Other participants were solicited via invitations posted on MyEndometriosisTeam’s Facebook page. Invitation to participate included a link to an anonymous survey.

RESULTS:
Of the 32,865 invited participants, 357 US women completed the survey with an 11% open rate and 10.3% response rate. Most respondents (83%) were between 19 and 29 years old; 85% reported to have discussed painful sex with a gynecologist, while only 33% were told their condition might be dyspareunia. Among those who did not seek help, 34% indicated that they were too embarrassed, while 26% did not think anything could lessen the pain. 42% of women agreed that it would be easier to discuss painful sex if the HCP initiated the discussion. Women reported that HCPs most often recommend surgery (46%) and over-the-counter pain medication (36%) for dyspareunia, while 18% provide no advice.

CONCLUSION:
In this online survey, the majority of women reported suboptimal communication with HCPs when seeking help for dyspareunia, highlighting the need for better dialogue about dyspareunia between patients and physician.
Impact of Perinatal Depression on Contraceptive Planning [4N]
Authors: Keesara Sirina , Kim Jo , Adams Marci , Silver Richard Karl 
Published: May 2019

INTRODUCTION:
Contraceptive choice may be influenced by disturbances in perinatal mood disorders, but studies have shown mixed results. We wished to assess the postpartum contraceptive choices of women at risk for perinatal depression, specifically in regard to hormonal contraception, long-acting reversible methods, and surgical sterilization.

METHODS:
This retrospective cohort study evaluated a population of women (n= 419) who participated in a calibration pilot for depression screening while pregnant and after delivery using a novel computerized adaptive diagnostic screener (CAT-MH). Maternal age, race and gestational age at delivery were used to match cases (n=64) to controls (1:2). Chart review was used to screen for choice of contraception and potential confounders including pre-pregnancy mental health disorders and/or current mental health treatments. Bivariate analyses and multiple logistic regressions were used to study the impact of depressive symptoms on contraceptive planning.

RESULTS:
No significant differences in contraceptive choice were observed between depressed and control groups. However, worsening postpartum mood was associated with the choice of non-hormonal methods when compared to stable mood after delivery (24.1% vs. 48.3%, p=0.016). This association persisted in a multivariate logistic regression which included age, race, insurance status, obstetric history, mode of delivery, and NICU admission. Women who were treated with psychiatric medications while pregnant were more likely to choose surgical sterilization (11.3% vs. 33.9%, p=.02).

CONCLUSION:
A relationship between depressed maternal mood and contraceptive planning may be mediated by preexisting mental illness and use of psychiatric medications, influencing both hormonal contraception and surgical sterilization choices.
Impact of the Ryan Program on Resident Clinical Experience and Intentions to Include Abortion in Future Practice [6N]
Authors: Steinauer Jody , Koenemann Katheryn , Coghlan Kearney , Landy Uta , Turk Jema 
Published: May 2019

INTRODUCTION:
This study assessed the impact of formal, opt-out family planning training on the clinical experience and intentions to include abortion care after residency among obstetrics and gynecology (ob-gyn) residents at currently funded Ryan Programs.

METHODS:
The Ryan Program (RP) has supported 99 US and Canadian ob-gyn residency programs to establish routine opt-out training in family planning and abortion. In this analysis we report on clinical experience and post-residency plans reported by residents after the family planning training at RPs in the last five years. Data were collected using Key Survey and descriptive analyses were conducted with STATA. This study was approved by the Institutional Review Board of the University of California San Francisco.

RESULTS:
Between September 2013 and 2018, 1,254 post-rotation surveys were completed by residents for a response rate of 70%. Residents did an average of 38 abortions on the rotation, including the 18% who opted out of portions of the training: 8 medication abortions, 11 manual uterine aspirations, 14 electric uterine aspirations, and 6 dilation and evacuations. When asked about their post-residency plans, 82% intend to do abortions for medical reasons and 59% for all reasons.

CONCLUSION:
Participation in a formal, opt-out family planning rotation resulted in significant clinical exposure to abortion procedures and plans to provide abortions after residency. Studies of ob-gyn residents between 1996 and 2014 have found that 30-40% planned to provide abortions after residency, suggesting that routine training is associated with plans to integrate abortion into obstetrics and gynecology practice.