bluuebunny/crossref_metadata_2025_split huggingface dataset:
Institutional Experience Using FIGO Protocol 2017 for First Trimester Miscarriages [28L]
Authors: Sepúlveda Rivera Cintia María , Mora Galván Jessica Aideé , Araujo Osvaldo Miranda , Ramírez Santés Victor Hugo 
Published: May 2019

INTRODUCTION:
A prospective study, conducted at Instituto Nacional de Perinatología (Mexico) from March to September 2018. Main objective was to evaluate the efficacy of misoprostol according to the International Federation of Gynecology and Obstetrics (FIGO) protocol 2017 in the management of first trimester miscarriages.

METHODS:
All patients first attending at urgency room diagnosed with first trimester miscarriages were given misoprostol according to FIGO protocol 2017. Via of administration varied according to physician. Efficacy was defined as complete uterine evacuation demonstrated by transvaginal scan on 7th day after misoprostol administration; if it was incomplete, an additional course was administrated.

RESULTS:
76 patients were diagnosed with first trimester miscarriage and were treated based on FIGO 2017 protocol. Via of administration was vaginal 36.8%, buccal 30.2%, sublingual 21%, combined 9.2% and oral 2.6%. Main indications were 66.6% missed abortion, 2.5% incomplete abortion and 1.7% anembryonic pregnancy. Mean gestational age was 7.9 weeks. Main comorbidities were myomatosis 9.2%, diabetes mellitus 6.5%, human papillomavirus infection 5.2%, hypothyroidism 3.9%, recurrent gestational loss 2.6% and others 7.8%. Most frequent effects were 72.3% transvaginal bleeding plus pelvic pain, 11.8% isolated transvaginal bleeding, 2.6% slight pain pelvic and 13.1% were asymptomatic. About the efficacy, 93.4% had complete uterine evacuation with one course, 6% required a second course. One patient required manual vacuum aspiration after the second course.

CONCLUSION:
Use of misoprostol according to FIGO 2017 protocol is effective for treating first trimester miscarriage. Via of administration do not affect effectiveness. Patient should receive counselling, follow up and must sign inform consent.
Intrapartum Group B Streptococcus Antibiotic Prophylaxis in Penicillin Allergic Pregnant Women [29L]
Authors: Desravines Nerlyne , Venkatesh Kartik , Hopkins Austin Mitchell , Grant Megan , McGuire Colleen , Boggess Kim A. 
Published: May 2019

INTRODUCTION:
To estimate the prevalence of inadequate intrapartum GBS antibiotic prophylaxis in penicillin-allergic pregnant women and identify potentially modifiable risk factors.

METHODS:
We conducted a retrospective cohort study of pregnant women within a medical center healthcare network from 01/1/2014-12/31/2017. Women were included if they 1) were GBS-colonized, defined as a positive urine or rectovaginal culture; 2) delivered at > 37 weeks' gestation, and 3) reported a penicillin/cephalosporin allergy. We excluded women with chorioamnionitis in labor, cesarean delivery without labor, or with incomplete data. Inadequate GBS prophylaxis was defined per CDC guidelines as the use of intrapartum antibiotics other than penicillin, ampicillin, or cefazolin. Multivariable logistic regression models adjusting for race and susceptibility testing were used to predict inadequate GBS antibiotic prophylaxis.

RESULTS:
Of 190 identified women, 5% reported anaphylaxis, 43% hives/shortness of breath/swelling, and 59% rash/itching/urticaria (not mutually exclusive). 63% of women received inadequate antibiotic prophylaxis. In adjusted analyses, non-white race (adjusted odds ratio (aOR): 2.42; 95% CI: 1.19-4.94) and reported reaction of hives/shortness of breath/swelling (aOR: 3.00; 95% CI: 1.54-5.83) were associated with higher odds of inadequate GBS antibiotic prophylaxis compared to those with mild or severe allergies. Those with a reported reaction of rash/itching/urticaria were less likely to receive inadequate prophylaxis (aOR: 0.39; 95 CI%: 0.20-0.77) compared to those with severe allergy.

CONCLUSION:
Inadequate intrapartum GBS antibiotic prophylaxis is frequent among term, penicillin/cephalosporin-allergic women. Efforts to confirm the severity of prior antibiotic allergic reactions and perform penicillin skin testing could potentially increase compliance with CDC guidelines.
Is Incision to Delivery Time Associated With Poor Neonatal Neurological Outcomes in Women With Class 3 Obesity? [31L]
Authors: Varvoutis Megan , Feldman Chelsea , Reiff Emily , Hughes Brenna L. , Grotegut Chad 
Published: May 2019

INTRODUCTION:
Morbid obesity has been associated with adverse neonatal outcome. We sought to determine factors associated with adverse outcome, specifically whether incision to delivery time (IDT) was an independent risk factor for poor neonatal outcome in a morbidly obese patient.

METHODS:
Secondary analysis of the MFMU Cesarean Registry. Inclusion criteria were singleton pregnancy, >37 weeks EGA and BMI >40 undergoing cesarean section. Patients were stratified into 2 groups: cesarean for fetal (fetal CS) and non-fetal (non-fetal CS) indications. The primary outcome was a neonatal composite of seizure, CPR <24 hrs, death, ventilatory support >2 d, HIE, pH <7.1 and APGAR 5 <5. Multivariate logistic regression was performed to assess impact of IDT and additional risk factors.

RESULTS:
The primary outcome was observed in 543 and 106 neonates (total n=6325) in the non-fetal CS and fetal CS subgroups respectively. Median IDT was 14.1 m for the non-fetal CS and 7.7 m for the fetal CS respectively. Women with poor neonatal outcome were more likely to be black race, affected by hypertensive diseases of pregnancy, higher BMI, have attempted labor, and have failed a VBAC attempt (Table 1). In the regression model, IDT>90th was not associated with adverse outcomes in the non-fetal CS group and was significantly associated with normal outcomes in the fetal CS group (Table 2).

CONCLUSION:
In the non-fetal CS subgroup, IDT >90th percentile was not associated with adverse outcomes. In the fetal CS subgroup, women with IDT >90th percentile were not associated with an increased risk of morbidity. Black race was associated with poor outcomes in both subgroups.
Counseling for Lubricant Use: The Importance of Sexual Activity and Product Specific Selection [37L]
Authors: Krychman Michael L. 
Published: May 2019

INTRODUCTION:
For the woman who suffers from genitourinary syndrome of menopause (GSM) moisturizers and lubricants remain the initial self-directed choice of intervention. There are a plethora of choices and appropriate product selection is often confusing, cumbersome and time-consuming. Lubricants choice differs with respect to characteristics and sexual activity.

METHODS:
An in-office survey was conducted in a random sampling of heterosexual women who attended a community sexual medicine clinic. Participants were anonymous and not financially compensated.

RESULTS:
Thirty women with a mean age of 46 (range 25-67) who were all users of lubricant were surveyed. Ninety-six (96%) of subjects reported improved comfort during coitus, and 87% report improved sexual enhancement whereas 97% reported improved overall sexual pleasure. No adverse effects were reported. Most (75%) preferred silicone over water based products. Many women who used flavored water lubricants said they enhanced sexual playfulness and enjoyment. On a Likert scale of 1-10 where (1 was completely dissatisfied with silicone as a lubricant and 10 most satisfied), participants rated silicone lubricant on average tat 9.1/10. Fifty percent of this sample engage in anal sex where as 70% engage in sexual intimacy in the bath/hot tub or shower and used silicone lubricant for these sexual events.

CONCLUSION:
Lubricant remains an important option for sexual play. Silicone lubricant offers an excellent choice for a variety of sexual situations, and has high patient acceptability, with noted improved sexual enhancement, pleasure and overall satisfaction. Water based lubes that have flavors may offer some dynamic sexual enjoyment for the couple.
Implementation of the Human Papillomavirus Vaccine in the Postpartum Period [39L]
Authors: Plisko Alexandra Marie , Hoyson Jessica Rose 
Published: May 2019

INTRODUCTION:
The human papillomavirus (HPV) is the most common sexually transmitted infection, with a lifetime prevalence of 80%. The Food and Drug Administration approved the HPV vaccine in 2006 which through research was found to prevent 95-100% of cervical, vaginal, and vulvar neoplasms as well as anogenital condylomatas in women naïve to HPV. Despite the data, vaccination rates remain low. We hypothesized that the implementation of a comprehensive protocol for the HPV vaccine postpartum would result in improved rates of vaccination in eligible women.

METHODS:
We performed a retrospective chart review of the OBGYN resident clinic patients. The pre-intervention data was collected from March 1, 2017 to August 31, 2017 and post-intervention data from October 1, 2017 to March 31, 2018.

RESULTS:
In the post-protocol group, the rate of HPV vaccination on the postpartum unit was 11.5%, while no patients received the vaccination in the pre-protocol group (P=.06). The percentage of post-protocol patients who received the HPV vaccination at the postpartum visit was 8% vs 2.6% for the pre-protocol patients (P=0.56).19.2% of post-protocol patients compared to 2.6% pre-protocol patients received the vaccination on the postpartum unit or at the postpartum visit (P=.036). Final vaccination rates were 18.4% for the pre-protocol patients and 53.8% for the post-protocol patients (P=.003). The percentage of patients who discussed the HPV vaccination was significantly higher in the post-protocol group with 61.5% vs the pre-protocol group with 0% (P<.001).

CONCLUSION:
Implementation of a comprehensive HPV vaccination protocol resulted in increased discussion of HPV vaccination and postpartum vaccination rates.
A Data-Driven Evaluation of the Size and Content of Expanded Carrier Screening Panels [1M]
Authors: Ben-Shachar Rotem , Svenson Ashley , Muzzey Dale 
Published: May 2019

INTRODUCTION:
The American College of Obstetricians and Gynecologists (ACOG) proposed seven criteria for expanded carrier screening (ECS) panel design. To ensure that screening for a condition is sufficiently sensitive to identify carriers and reduce residual risk of non-carriers, one criterion requires a per-condition carrier rate greater than 1-in-100. However, it is unestablished whether this threshold corresponds with a loss of clinical detection. The manner in which these criteria are interpreted and implemented could have an appreciable effect on the ability of ECS to detect at-risk couples. Yet, there has been no data-driven evaluation of the impact of these criteria.

METHODS:
Carrier rates and at-risk couple rates were calculated in 56,281 patients who underwent a 176-condition ECS and evaluated for panels satisfying various criteria. Condition-specific clinical sensitivity was estimated via simulation. This study was exempt from IRB oversight.

RESULTS:
Different interpretations of the 1-in-100 criterion have variable impact: a compliant panel would include between 3 and 38 conditions, identify 11%-81% fewer at-risk couples, and detect 36%-79% fewer carriers than a 176-condition panel. We found no conspicuous change in the ratio of the marginal panel carrier rate relative to the marginal at-risk couple rate that would motivate a 1-in-100 carrier-rate threshold. Simulations suggest that the clinical detection rate remains >84% for conditions with carrier rates as low as 1-in-1000, with detection rates sensitive to condition-specific variant-frequency distributions, which we have compiled.

CONCLUSION:
The 1-in-100 criterion should be reconsidered because it limits at-risk couple detection without substantially easing the burden of testing partners of carriers.
Effectiveness of a Digital Fertility Awareness-Based App for Contraception in the United States [4M]
Authors: Rowland Simon , Kallner Helena Kopp , Gemzell-Danielsson Kristina , Trussell James , Scherwitzl Elina Berglund , Scherwitzl Raoul 
Published: May 2019

INTRODUCTION:
There is an unmet need for effective, non-hormonal methods of contraception. Natural Cycles is a digital fertility awareness-based method of contraception delivered in the form of a mobile app. The aim of this study was to assess the effectiveness of the app in a cohort of women from the United States (US).

METHODS:
Data from 18,304 users registered between August 2014 and November 2017 were included in the analysis. Participants were included if they were between 18 and 45 years of age and had at least 20 daily data entries. Questions addressing key characteristics (age, body mass index (BMI) and previous hormonal contraception) were mandatory for onboarding into the app. Other demographics were assessed through in-app messaging. Contraceptive effectiveness during typical use was calculated as both a 13-cycle cumulative probability of pregnancy from a life-table analysis and as a one-year Pearl Index (PI). (EPN, Stockholm, diary number 2017/563-31).

RESULTS:
The mean age of users of the application was 29 years and mean BMI was 22. The majority of the cohort had a university degree or higher (74.8%) and reported being in a stable relationship (85.7%). The 13-cycle failure rate was 6.2% ± 0.5 and the one-year PI was 5.9 ± 0.2.

CONCLUSION:
In this real-world observational study, this digital fertility awareness-based method of contraception had a 13-cycle failure rate of 6.2% in a cohort of users from the US. This is in-line with the typical-use failure rates of Natural Cycles users globally.
Evaluation of a Rapid Urine Test for Preeclampsia in an Antenatal Triage Population [7M]
Authors: Fryer Hugh J.L. , Rood Kara M. , Davis Wendy L. , Buhimschi Catalin Sorin , Buhimschi Irina A. 
Published: May 2019

INTRODUCTION:
Preeclampsia-associated morbidity and mortality is most often due to a delay or misdiagnosis Recent studies showed misfolded proteins can be detected in urine of preeclamptic women. The previous research assay has been transitioned to a manufacturable diagnostic device. Here we present the clinical accuracy of the in vitro diagnostic device (GV-CR) intended as an aid in the diagnosis of preeclampsia.

METHODS:
We evaluated 346 frozen urine samples from a prospective study of women referred to a L&D triage center for rule-out preeclampsia. 89 (26%) patients were diagnosed with preeclampsia by expert adjudication with reference to the ACOG 2013 Guidelines. Results were visually scored at 3 minutes after urine was applied to the test device. The user was blinded to case diagnoses. Test results were compared to the adjudicated diagnosis. IRB approval was obtained.

RESULTS:
The cohort comprised 52% multiparous, 91% overweight/obese, 38% early preterm, 31% late preterm, and 31% at term women. Cases were particularly challenging and ambiguous to at least one physician who referred for rule-out preeclampsia. Results showed an 84.1% (95% CI: 75.1-90.3) sensitivity, 76.8% (95% CI: 71.0-81.7) specificity, and a negative predictive value of 93% for the device compared to the adjudicated diagnosis.

CONCLUSION:
This 3-minute urine test demonstrated strong correlation with an adjudicated diagnosis of preeclampsia in this cohort of complex cases referred with an uncertain diagnosis and holds promise as an aid in the diagnosis of preeclampsia. Multicenter clinical studies are warranted.
Nursing Students’ Professional Value Development: Can We Do Better?
Authors: Feller Lisa M. , Fisher MaryDee , Larson June , Schweinle William 
Published: May 2019

Abstract

AIM
The purpose of this study was to identify whether differences exist in nursing professional values based on program type and/or geographic location.

BACKGROUND
Deliberate inclusion of values formation is critical to nursing education and high-quality nursing care. There is limited research comparing professional values development among students in all types of prelicensure RN programs and no research comparing students’ professional values between geographic regions.

METHOD
A secondary analysis was completed of original data collected in three descriptive studies using the Nursing Professional Value Scale-Revised®.

RESULTS
Findings indicate prelicensure nursing students are educated with the values integrated within the American Nurses Association Code of Ethics. Significant differences (p < .05) were found when comparing geographic locations, program types, and Nursing Professional Value Scale-Revised factor scores.

CONCLUSION
Additional research is needed to identify best practices for overall values formation in all program types.
Underrepresentation of Racial Diversity in Simulation: An International Study
Authors: Foronda Cynthia , Prather Susan L. , Baptiste Diana , Townsend-Chambers Colette , Mays Linda , Graham Crystal 
Published: May 2019

Abstract

AIM
The purpose of this study was to: 1) examine the presence of racial diversity in simulation centers globally and 2) determine the opinion of the simulation community related to incorporation of a diversity component into international simulation standards.

BACKGROUND
Leading organizations in nursing education recommend improved efforts toward diversity and inclusion. Research suggests a lack of diversity in simulation-based education.

METHOD
This study employed a mixed-methods design.

RESULTS
Quantitative results demonstrated an underrepresentation of racial diversity in manikins, body parts/task trainers, standardized patients, and simulation facilitators. Two thirds of respondents indicated that international simulation standards should recommend a diversity component. Qualitative findings indicated categories of: 1) challenges of purchasing, realism, and availability; 2) importance of diversity in simulation; 3) representation of the regional population; 4) more diversity considerations needed; and 5) presence of diversity.

CONCLUSION
There is a continued need for diversity advocacy efforts in nursing education.
Therapeutic approach of anaphylaxis
Authors: Tanno Luciana Kase , Alvarez-Perea Alberto , Pouessel Guillaume 
Published: May 2019

Purpose of review
Anaphylaxis is a recognized cause of death in all ages, which requires prompt recognition and treatment. We here propose to review the current and new pharmacological treatment of anaphylaxis in the view of the new knowledge in the field that can support the quality practice and empower allergists and health professionals with new tools that can be used to treat symptoms and prevent anaphylaxis.

Recent findings
The recent description of phenotypes provides new insight and understanding into the mechanisms and causes of anaphylaxis through a better understanding of endotypes and application of precision medicine. Several biologic therapies and new devices are emerging as potential preventive treatment for anaphylaxis.

Summary
Adrenaline (epinephrine) is still the first-line treatment for any type of anaphylaxis and is recognized as the only medication documented to prevent hospitalizations, hypoxic sequelae and fatalities. β2-adrenergic agonists and glucagon remains as the second-line treatment of anaphylaxis, meanwhile glucocorticoids and antihistamines should be used only as third-line treatment. Their administration should never delay adrenaline injection in anaphylaxis. More intuitive adrenaline autoinjectors design and features are required as well as a worldwide availability of adrenaline autoinjectors. Biological drugs, such as omalizumab, have been used as therapeutic adjuvants as a preventive treatment of anaphylaxis, but cost-effectiveness should be considered individually. Understanding the specifications of underlying mechanisms can potentially support improvements in the patients’ allergological work-up and open the opportunity of developments of potential new drugs, such as biological agents. Expanding knowledge with regard to the presentation, causes, and triggers for anaphylaxis among healthcare providers will improve its diagnosis and management, increase patient safety, and decrease morbidity and mortality.
Serum Biomarkers for the Early Detection of the Early-Onset Neonatal Sepsis
Authors: Ahmed Ali Mahmoud , Mohammed Abdelrahman Tarek , Bastawy Samah , Attalla Hams Ahmed , Yousef Aly Abdelrahman , Abdelrazek MennatAllah Sayed , Fransawy Alkomos Mina , Ghareeb Ahmed 
Published: May 2019

Background:
Reducing the hazards of the early-onset neonatal sepsis (EONS) is a priority justifying the further investigation for potential biomarkers for its early diagnosis.

Purpose:
We aimed to investigate the diagnostic value of presepsin, procalcitonin, lactoferrin, interleukin (IL)-6, and IL-8 for the early diagnosis of EONS.

Methods:
A prospective comparative study, including 30 cases with highly suspected EONS and 30 matched controls, was conducted. Besides the complete blood count and blood culture, C-reactive protein, procalcitonin, presepsin, IL-6, IL-8, and lactoferrin were measured at the admission and after 72 hours.

Results:
At the time of the admission, presepsin, procalcitonin, C-reactive protein, and IL-8 were significantly higher in the sepsis group. The levels of presepsin, procalcitonin, and IL-8 significantly decreased after 72 hours of the admission. Presepsin, procalcitonin, IL-8, and IL-6 showed a high diagnostic ability for sepsis at admission with area under the curve of 0.934, 0.798, 0.775, and 0.751, respectively. The cutoff values of presepsin, procalcitonin, IL-8, and IL-6 were 821 pg/mL, 2.3 ng/mL, 54 pg/mL, and 24 pg/mL, with a sensitivity of 88.9%, 72.2%, 83.3%, and 94.4% and specificity of 85.7%, 80.9%, 71.4%, and 52.4%, respectively. Lactoferrin had the lowest diagnostic ability with area under the curve of 0.558.

Implications for Practice:
Presepsin was the most accurate biomarker followed by procalcitonin, IL-8, and IL-6 regarding the early diagnosis and management of EONS. The combination between these biomarkers is highly recommended.

Implications for Research:
Further studies are needed to investigate the diagnostic ability of the combination of these biomarkers.
Predicting disease severity and remission in juvenile idiopathic arthritis: are we getting closer?
Authors: Guzman Jaime , Oen Kiem , Loughin Thomas 
Published: May 2019

Purpose of review
To summarize current research on the prediction of severe disease or remission in children with juvenile arthritis, and define further steps needed towards developing prediction tools with sufficient accuracy for clinical use.

Recent findings
High disease activity, poor patient-reported outcomes, ankle or wrist involvement, and a longer time from onset to the start of treatment herald a severe disease course and a low chance of remission. Other studies confirmed that age less than 7 years and positive ANA are the strongest predictors of uveitis development. Preliminary evidence suggests ultrasound findings may predict flare in patients with clinically inactive disease, and several new biomarkers show promise. A few prediction tools that combine predictors to estimate the chance of remission or a severe disease course in the medium-term to long-term have shown good accuracy when internally validated in the population in which they were developed.

Summary
Promising candidate tools for predicting disease severity and long-term remission in juvenile arthritis are now available. These tools need external validation in other populations, and ideally formal trials to assess whether their use in practice improves patient outcomes. We are definitively getting closer, but we are not there yet.