bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Impact of Resident Education on Clinical Outcomes in Vaginal Hysterectomies [3F]
Authors: Lababidi Suzanne , Winfrey Olivia K. , Shammout Fadel 
Published: May 2019

INTRODUCTION:
Resident involvement in surgical procedures is a critical component of resident education. As learners train, it is important to recognize the impact this has on patient outcomes. This project aims to describe the association between resident involvement in vaginal hysterectomies and patient outcomes.

METHODS:
The National Surgical Quality Improvement Project database was used to collect data on patients who underwent a vaginal hysterectomy from 2007 and 2012. Patients with incomplete data were excluded. Logistic and linear regression models were used for analysis. Significance was set at P=.05.

RESULTS:
A total of 7,838 patients were included. Of those, 38.6% of procedures included a resident and 61.4% were performed by an attending alone. Resident participation was associated with an increase in operative by 36.5 minutes, on average (P<.001, 95% CI 34.1-39.0). Resident involvement had no effect on post-operative length of stay (P=.953, OR 0.003, 95% CI -0.79-0.84), superficial surgical site infection (SSI) (P=.395, OR 1.285, 95% CI 0.722-2.287), organ space SSI (P=.135, OR 1.425, 95% CI 0.895-2.269), wound dehiscence (P=.182, OR 3.178, 95% CI 0.582-15.362), bleeding complications requiring transfusion (P=.540, OR 1.135, 95% CI 0.755-1.709), peripheral nerve injury (P=.342, OR 2.383, 95% CI 0.398-14.269), reoperation (P=.937, OR 1.042, 95% CI 0.376-2.890), or readmission (P=.725, OR 1.128, 95% CI 0.576-2.207).

CONCLUSION:
Inclusion of residents in surgical cases was not associated with any differences in complications measured with only a minor increase in operative time. This demonstrates the minimal impact of resident education on clinical outcomes, further arguing the need to include residents in cases whenever possible.
Barriers to Prenatal Care by Race/Ethnicity in Multiparous Women [27F]
Authors: Fryer Kimberly E. , Munoz Chris , Rahangdale Lisa , Stuebe Alison M. 
Published: May 2019

INTRODUCTION:
Patients who are late to prenatal care miss valuable opportunities for health interventions, and are at increased risk for pregnancy-related complications. In our study, we aimed to describe barriers to prenatal care experienced by multiparous women with an interconceptional period of less than two years by race/ethnicity.

METHODS:
After IRB approval, we performed a secondary analysis of the Community Child Health Research Network Study, a multi-site prospective cohort study of pregnant women from 2008 to 2012 recruited from Baltimore, Chicago, North Carolina, Los Angeles and Washington, D.C. Participants who experienced a repeat pregnancy in the two-year follow up period were asked if they encountered any of eight prespecified potential barriers to prenatal care. A multilevel mixed effects Poisson regression was performed to evaluate the association between race/ethnicity and number of prenatal barriers encountered.

RESULTS:
We included 298 participants in our analysis, with 151 self-identifying as African American, 72 White, and 75 Latina. The most frequent barrier was the inability to obtain an appointment. Overall, 43% of African American, 35% of Latina, 23% of White participants reported barriers to care. After adjusting for study site, maternal education, language, and maternal age, African American and Latina women reported almost twice as many barriers to prenatal care as White women (OR 1.89 [1.2, 3.0]; 2.00 [1.1,3.8], respectively).

CONCLUSION:
In our secondary data analysis of a multisite, longitudinal cohort, multiparous African American and Latina women reported encountering more barriers to obtaining prenatal care. Additional interventions are needed to address these barriers and achieve health equity.
Difference in Glycemic Profile With the Pump vs Multiple Daily Injections in Treating Type 1 Diabetes in Pregnancy [32F]
Authors: Smrz Stacy , Finneran Matthew M. , Landon Mark B. , Gabbe Steven G. 
Published: May 2019

INTRODUCTION:
Previous literature suggests that patients with type 1 diabetes (T1DM) utilizing continuous subcutaneous insulin infusion (CSII) have lower hemoglobin A1c values compared to multiple daily injections (MDI). Despite improved glycemic control, rates of large for gestational age (LGA) infants are not different between these groups. This study investigates differences in glycemic profiles between CSII and MDI glucose logs.

METHODS:
Retrospective cohort study of all singleton pregnancies complicated by T1DM from 2012-2016. Patients were separated into groups by insulin delivery method. Glucose logs were reviewed for each trimester and a median glucose, interquartile range (IQR), and glycemic variability (IQR/median glucose) were calculated. Continuous data was compared using the Wilcoxon rank sum test. Spearman correlation coefficients were calculated comparing trimester specific median glucose and glycemic variability with neonatal birth weight percentile.

RESULTS:
117 patients met inclusion criteria with 37,262 fasting and post-prandial values recorded. The rate of LGA was not different between groups (CSII: 57%, MDI: 49%; p=.370) despite CSII users having both a lower early A1c (<20 weeks [6.8% vs. 8.6%; <.001]) and late A1c (>26 weeks [6.5% vs. 6.9%; p=.008]) when compared to MDI users. Median reported glucose values were similar between groups, but glycemic variability was substantially increased in CSII users. However, glycemic variability did not correlate with birthweight percentile in any trimester independent of insulin delivery method.

CONCLUSION:
Patients using CSII have lower A1c values, but significantly more glycemic variability when compared to MDI users. However, degree of glycemic variability does not correlate with neonatal birthweight percentiles.
Who Is Harmed When Labor Floors Are Busy? A Racial Disparities Analysis [27T]
Authors: Gourevitch Rebecca A. , Plough Avery , Donato Katherine , Shah Neel 
Published: May 2019

INTRODUCTION:
Busyness on labor and delivery floors is associated with higher odds of interventions and adverse maternal outcomes. Other studies suggest that providers' implicit biases are activated during busy times. We test the hypothesis that the “busyness effect” is more pronounced for black women than for white women.

METHODS:
We ran race-stratified logistic regressions to estimate whether delivering at busier times was associated with higher odds of birth interventions or adverse outcomes for the mother or neonate, controlling for hospital and other factors. The data included linked birth certificate and claims data for all births at 21 hospitals in Philadelphia from 1996-2010 (n=290,169 births).

RESULTS:
Within a hospital, delivering at a busy time is associated with increased odds of interventions for both white women (OR=1.08, 95% CI (1.03,1.14)) and black women (OR=1.07, 95% CI (1.04,1.12)); however, it is only associated with increased odds of adverse maternal outcomes for black women (OR=1.06, 95% CI (1.02,1.10)), not for white women (OR=1.01, 95% CI (0.96,1.06)). Busyness is not associated with adverse outcomes for neonates. These results hold after excluding hospitals with racially homogenous patient populations.

CONCLUSION:
Busyness on labor and delivery floors is associated with increased odds of adverse maternal outcomes for black women, but not for white women, which could contribute to racial disparities in maternal outcomes. Further research is needed to better understand this association.
Dorsal Root Ganglion Stimulation for Chronic Pelvic Pain [39T]
Authors: Patel Kiran V. 
Published: May 2019

INTRODUCTION:
Historically, pelvic pain has been a difficult condition to treat partially due to the complex nature of the pelvic neuroanatomy. The pelvis receives the majority of its innervation from the sacral plexus, with contributions from the lower lumbar nerve roots, and hypogastric plexus autonomic fibers. Dorsal root ganglion (DRG) stimulation at L1 and S2 (an off label indication) allows for targeted coverage of pelvic pain and referred pain commonly felt into the lower back and groin areas.

METHODS:
We report a case series of 15 patients with various etiologies of chronic pelvic pain. Percutaneous DRG leads were placed at L1 and S2. Following a 7 day trial of a temporary device, all patients elected to proceed with permanent implantation of bilateral L1 and S2 leads. NRS and modified ODI scores were followed pre-trial, trial, 3, 6, 9, 12 and 18 months post implant (where applicable).

RESULTS:
At 3 months post implant, all 15 patients reported an improvement from crippled to minimal disability and a 70-90% decrease in NRS. All patients reported improving symptoms and less interference of pain with activities of daily living. As patients were followed to 6, 9, 12, and 18 months respectively the decrease in modified ODI and NRS remained consistent or displayed further improvement. 13 out of 15 patients, were able to stop taking opioid medication following the initiation of DRG therapy for pelvic pain.

CONCLUSION:
DRG therapy may provide a reproducible, specific and effective treatment for patients with chronic pelvic pain syndromes that have previously failed conservative therapies.
Why Do You Want It Out?: Provider Perspectives on Early LARC Removal [7S]
Authors: Isley Michelle Marie , Brown Melissa , Rivlin Katherine , Keder Lisa M. , Norris Alison 
Published: May 2019

INTRODUCTION:
Providers promote long-acting reversible contraception (LARC) because LARCs are highly effective at preventing pregnancy. The FDA recommends a maximum length of time for LARC use, but not a minimum. When women requesting early LARC removal perceive resistance from their providers, frustration and damaged patient-provider relationships can result. Understanding provider attitudes and practices about LARC removal is vital to patient-centered care.

METHODS:
Ten interviews were conducted with LARC providers and analyzed using qualitative techniques. LARC providers included physicians and mid-level providers in Ob/Gyn, pediatrics, and family medicine, in academic and community settings. Transcribed interviews were coded for themes and analyzed using a modified grounded theory approach. NVivo software was used for analysis.

RESULTS:
Providers defined early LARC removal as two weeks after insertion to anything prior to device expiration. Providers highlighted the importance of respecting patient autonomy when early LARC removal was requested, but many felt that patients should try LARC for a minimum amount of time to acclimate to the device or because of cost. Providers want to know why LARC removal is desired so that patient can be reassured and side effects can be treated to possibly delay or prevent removal. Many providers expressed internal conflict about early removal. They felt strongly about the benefits of LARC and disappointment or irritation with patients when LARC is removed early.

CONCLUSION:
Providers feel conflicted between their desire to promote effective birth control and patient requests for early LARC removal. Training around LARC provision and removal should include emphasis on the importance of patient-centered care.
Cost-Effectiveness of Prophylactic Tranexamic Acid Use in Women at Increased Risk of Postpartum Hemorrhage [22B]
Authors: Howard Dagnie C. , Skeith Ashley , Caughey Aaron B. 
Published: May 2019

INTRODUCTION:
Postpartum hemorrhage (PPH) is a leading cause of pregnancy-related morbidity and mortality. Tranexamic acid (TXA), an antifibrinolytic agent, has been shown to reduce morbidity and mortality as a treatment for active hemorrhage. However, the incidence of postpartum hemorrhage varies widely and is heavily influenced by a number of risk factors. Our objective was to determine the rate of postpartum hemorrhage at which the use of prophylactic TXA becomes cost-effective.

METHODS:
A decision analytic model was designed using TreeAge software in order to compare the outcomes and costs of TXA use in the prevention of PPH associated morbidity and mortality. The outcomes analyzed in the model were death due to hemorrhage and need for surgical intervention to control bleeding. Probabilities, utilities, and costs were derived from the literature.

RESULTS:
A one-way sensitivity analysis was done to look at the cost-effectiveness of TXA prophylaxis based on risk of postpartum hemorrhage. TXA prophylaxis was shown to be cost effective at risks of 0.0034 or greater based on a willingness-to-pay threshold of $100,000 per QALY. Additionally, in women at high risk of PPH due to morbidly adherent placenta, prophylactic TXA administration in a theoretical cohort of 100,000 women would prevent 270 maternal deaths due to hemorrhage. This amounts to an increase in 7,332 QALYs at a cost/QALY of $458.

CONCLUSION:
Prophylactic administration of TXA is a cost-effective strategy for reducing maternal morbidity and mortality in women at increased risk of PPH.
Interpregnancy Intervals, LARC Use, and Preterm Birth: A Retrospective Cohort Study [8M]
Authors: Sanders Jessica , Simonsen Sara E. , Leiser Claire , Hanson Heidi , Lynen Richard F. , Law Amy 
Published: May 2019

INTRODUCTION:
Preterm birth (PTB, defined as a live birth at <37 weeks' gestation) is a major determinant of poor neonatal outcomes. Short interpregnancy interval (IPI, defined as <18 months) is an important risk factor for PTB. A growing number of U.S. women use highly-effective, long-acting reversible contraception (LARC) to space pregnancies. In this retrospective cohort study, we examined the association between interpregnancy LARC use, IPI, and PTB.

METHODS:
Electronic medical records from two health systems were probabilistically linked to birth and fetal death records. Women with a first and second live birth (2005-2015) who received non-emergent care within 10 years of the first birth were included. Data on contraceptive encounters were abstracted using ICD-9/10 and CPT codes; birth outcome data came from state birth certificates. Multivariable regression was used for data analysis, adjusting for IPI, education, presence of father, mother's age, Hispanic ethnicity, fetal anomalies, and PTB history.

RESULTS:
Of 35767 women in the cohort, 3063 had evidence of interpregnancy LARC exposure, 901 had a non-LARC contraceptive encounter and 31803 had no record of any contraceptive-related care. Women with LARC exposure were significantly less likely to have short IPIs (p<.0001). Preterm birth occurred in 6.40% of second births (n=2288). Women with interpregnancy LARC did not have a decreased risk for PTB (1.054 adjusted OR, 0.905-1.229 95%CI) compared to women with no contraceptive encounters.

CONCLUSION:
LARC exposure is associated with a reduction in short IPIs, but LARC use between the first and second birth had no effect on preterm birth when controlling for IPI.
A Novel Device Improves Vaginal Tissue Retraction & Patient Comfort in Gynecological Exams [10M]
Authors: Warhus Damon A. , Kellogg Spencer 
Published: May 2019

INTRODUCTION:
Excess vaginal tissue is present in multiparous women limiting clinician access/visualization of cervix. Clinicians often use longer/larger speculum or cut the tip of a condom/glove and position it on the speculum with limited success. A novel class-II FDA-exempt device can be used with most speculum to retract sidewalls.

METHODS:
An IRB-approved (ClinicalTrials. gov, # NCT03123367) interventional, randomized, controlled, parallel-assignment study evaluated the device (Nella VuSleeve) across two sites. 40 women were enrolled (n=20 device, n= 20 control) with BMI between 20-50 (mean 33) or with two or more vaginal births. Of the 40-patients, results for 32 with BMI ≥30 are presented, of which 15 were in device-arm, and 17 in control-arm. Control-arm used a speculum without novel device. Study-patients all signed an informed consent form.

RESULTS:
Clinicians strongly-agreed/agreed that novel device helped them in a) 100% of exams to retract patient's vaginal tissue better than if it had not been used. b) In 80% of exams to visualize and access the cervix better than if it had not been used. 100% of patients in device-arm strongly-agreed/agreed that the speculum was comfortable overall as compared to 88% in control-arm. 80% of patients in device-arm also stated that their exam was significantly-better/better than their previous exam, compared to 59% in control-arm.

CONCLUSION:
In women with elevated BMI, the new device successfully retracted vaginal sidewalls helping to improve visualization/access to the cervix. The device also helped increase patient comfort that could lead to better patient satisfaction scores (an important quality metric) and visit compliance.
Association Between History of Sexual Trauma and Unstable Housing [14M]
Authors: Leigh Jennifer , Pearson-Ayala Savannah , Rajeev Pournami , Torresan Mirella , Ades Veronica 
Published: May 2019

INTRODUCTION:
Socioeconomic stress can serve as both a risk factor for or consequence of experiences of sexual violence, affecting survivors' ability to access and engage with medical care. This study examines whether survivors of sexual violence recruited in a New York City hospital setting are more likely to report socioeconomic stress than patients who have not experienced sexual violence, and which stressors survivors are most likely to report.

METHODS:
This is a secondary analysis of a cross-sectional cohort study comparing women with known sexual trauma to unexposed controls. IRB approval and patient informed consent were obtained. Participants were administered a structured interview using several questionnaires, including the traumatic life experiences questionnaire and questionnaires on economic hardship. Data were analyzed via REDCap.

RESULTS:
Of 21 women examined, 10 (48%) had experienced sexual trauma (exposed), and 11 (52%) had not (control). Difficulty finding affordable housing was reported by 7 (70%) exposed women and 3 (27%) control women (p=0.07). 9 (90%) exposed women reported having to stay with family, friends, or in a shelter compared to 1 (9%) control woman (p<0.0001). 2 (20%) exposed women and none of the control women had been evicted (p=0.14). When the three measures were examined as a composite variable of unstable housing, 9 (90%) exposed women had experienced unstable housing, while 3 (27%) control women had (p=0.04).

CONCLUSION:
The findings of this study suggest that survivors of sexual violence are more likely to have unstable housing compared to women who have not experienced sexual violence, though a larger study is needed.
A Case Series of Patient Complications Following Vaginal Laser Treatment for Atrophy [17M]
Authors: Gordon Catherine , Bell Stacie , Hauser Henry , Krychman Michael L. 
Published: May 2019

INTRODUCTION:
Approximately 40-80% of postmenopausal women endure a variety of symptoms associated with genitourinary syndrome of menopause (GSM). Currently, many treatment options exist for this condition, including laser treatment. While the FDA has cleared fractional CO2 laser for a variety of indications, lasers have not to date, been approved for use for vaginal atrophy or dyspareunia. Randomized, sham-controlled clinical study data showing efficacy and safety remains sparse.

METHODS:
Two case studies referred to a tertiary sexual medicine center regarding laser treatment complications are reported.
Case 1: After completing 3 CO2 vaginal laser treatments, the 62-year-old woman was given approval for sexual intercourse. Immediately following intercourse, she reported heavy bleeding and went to the hospital. Upon examination, two vaginal wall lacerations were noted and repaired. Currently, she has a moderate amount of vaginal fibrosis and can only engage in sexual intercourse utilizing several treatment options.
Case 2: A 63-year-old woman complaining of painful intercourse following the first of 3 CO2 vaginal laser treatment which got progressively worse following the remaining two treatments. The patient reports a sharp decline in sexual life. Currently she is undergoing aggressive vaginal rehabilitation.

CONCLUSION:
While vaginal laser therapy shows promise for GSM treatment in some women, no intervention is without potential adverse events. Complications of fibrosis, scarring, and penetration injury are emerging following laser treatments. Currently, FDA approved products for GSM should be considered front line treatments for GSM and long-term, randomized, sham-controlled clinical trials should be conducted to ascertain the efficacy and safety of novel GSM treatments.
Spiking in the Second Stage: The Significance of Isolated Maternal Fever During Labor [16A]
Authors: Smith Megan , Daifotis Helen , Denoble Anna Elisabeth , Dotters-Katz Sarah Kathleen 
Published: May 2019

INTRODUCTION:
ACOG recommends management of isolated maternal fever (IMF) be at the provider's discretion. However, signs of infection are difficult to interpret in the 2nd stage of labor; patients with IMF may be less likely to receive treatment for presumed infection. Our study compares postpartum maternal outcomes between women who received and did not receive antibiotics for IMF in the 2nd stage.

METHODS:
Retrospective cohort study of women experiencing IMF (38.0-38.9C) during the second stage of labor at a tertiary institution who didn't meet criteria for intraamniotic infection. Singleton and twin vaginal deliveries included. Women who received antibiotics (treated) were compared with untreated subjects. Primary outcome was maternal morbidity: postpartum infection (endometritis, perineal infection, sepsis), blood transfusion, dilation and curettage, postpartum venous thromboembolism, or hospital readmission. Data compared using bivariate statistics. Logistic regression included statistically significant variables. This study was IRB approved.

RESULTS:
Among 127 women, 84 (66.1%) received antibiotics. Demographic data, antepartum complications, timing of delivery, and delivery characteristics did not differ. Nineteen women (15.0%) had adverse maternal outcomes: 10 (11.9%) in the antibiotic group and 9 (20.9%) in the untreated group (P=0.20). Five women in each group had postpartum infections (P=0.31). Three (7.1%) untreated, and 2 (2.4%) treated women received a blood transfusion (P=0.33). Readmission was twice as common in the treated group (4.8% vs 2.3%, P=0.66). When controlling for delivery BMI, antibiotic receipt was not associated with decreased odds of adverse maternal outcomes (aOR 0.76, 95% CI 0.26, 2.23).

CONCLUSION:
Nearly 1/6 women experienced an adverse postpartum outcome after IMF in the 2nd stage of labor. Antibiotic receipt didn't protect against these outcomes.