bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Physician Gender Selection on Patient's Perceptions of Experience With Women's Health [9K]
Authors: Turrentine Mark , Ramirez Mildred , Stark L. M. , Snead Carrie , Schulkin Jay 
Published: April 2018

INTRODUCTION:
To evaluate women's attitudes about the role of obstetrician-gynecologists (ob-gyn) gender selection and their perceptions of knowledge, experience, and understanding with women's health.

METHODS:
Two large private practice ob-gyn groups anonymously surveyed patients at scheduled office visits to explore the role of gender in the selection of their ob-gyn and their perceptions of the physician's knowledge, experience, and understanding with women's health. The Mann-Whitney U test was utilized for comparisons.

RESULTS:
In 2017, 996 patients were surveyed with 803 returned (81% response rate). Women who saw a female physician were more likely to be younger (36 versus 39 years) and married (88% versus 82%) than women seen by a male. Women who saw female ob-gyns (compared to those that saw a male) reported that the gender of their physician was important to them (62% versus 20%, P<.01). Women who saw a female ob-gyn perceived their physicians have a greater knowledge (27% versus 3%, P<.01), experience (51% versus 14%, P<.01), and understanding (54% versus 8%, P<.01) with women's health in comparison to women who choose a male. The top three rank-order reasons women choose a female ob-gyn were physician ratings, gender, and office location. In contrast, the reason women choose a male ob-gyn were physician ratings, availability, and office location.

CONCLUSION:
Women who seek a female ob-gyn feel strongly about the gender and have perceptions their physicians are more knowledgeable, experienced, and understanding about women's health compared to a male ob-gyn.
The Risk of Cesarean Delivery as Related to Maternal Height and Race [16K]
Authors: Skeith Ashley E. , Caughey Aaron B. 
Published: April 2018

INTRODUCTION:
We sought to determine differences in the rate of cesarean delivery associated with maternal height as related to race.

METHODS:
We conducted a retrospective cohort study of 9,208,030 women with singleton, non-anomalous, vertex, term gestations from 2012 to 2014 and examined rates of cesarean delivery based on maternal height and race. Maternal height was divided into 2-inch increments and race was classified as Asian, Hispanic, White, or Black. Results were stratified by parity and history of previous cesarean delivery. Chi-square tests were employed for statistical comparisons and a P-value of less than 0.05 was used to indicate statistical significance.

RESULTS:
Overall, we found that maternal height is inversely related to risk of cesarean delivery, regardless of race. The overall odds ratio of cesarean delivery as related to increasing maternal height is 0.93 (95% confidence interval [CI], 0.9309–0.9321). When stratified by race, our results showed that height is most protective for Asians (OR 0.91, 95% CI 0.909–0.918) and least protective for Hispanics (OR 0.95, 95% CI 0.946–0.949), indicating that for every 2-inch increase in maternal height, there is a 9% reduction in risk of cesarean delivery in Asian women, but only a 5% reduction in risk for Hispanic women.

CONCLUSION:
Maternal height modifies the risk of cesarean delivery, which varies based on race. Though stature as related to race has not typically been included in prenatal counseling for women, it may be reasonable to alter counseling based on these patient characteristics.
The Decision to Admit for Threatened Preterm Birth [25K]
Authors: Fisher Lytia , Lewis Dawnette , Waldron Carolyn , Pan Stephanie 
Published: April 2018

INTRODUCTION:
Preterm labor (PTL) is the most common reason for antepartum hospital admission, yet only 10% of those presenting will deliver within 7 days, while 30% resolve spontaneously. The American College of Obstetricians and Gynecologists (ACOG) defines PTL as regular uterine contractions with change in cervical dilation and/or effacement, or regular contractions with cervical dilation of at least 2 cm. We hypothesized that the majority of patients admitted for PTL do not meet ACOG criteria and have lower prevalence of preterm birth.

METHODS:
This IRB-approved, retrospective chart review included all PTL admissions of singleton pregnancies less than 37 weeks gestation at Mount Sinai West from October 1, 2012 to October 1, 2016, excluding those with membrane rupture, pre-eclampsia, or abruption. Statistics included χ2, Student t-test, and multivariable logistic regression.

RESULTS:
PTL admissions (n=179) were divided into those that met ACOG criteria on first admission (n=73) and those that did not (n=106). Patients who did not meet ACOG criteria had a much lower prevalence of preterm birth than those who did (40/92 [41.2%] versus 55/67 [82.1%]; P<.001), and the ACOG group was more likely to deliver on first admission (53/71 [74.7%] versus 19/104 [18.3%]; P<.001). Demographics were comparable between groups, except median gestational age at admission was higher for the ACOG group (35.1 [33.1–36.3] versus 30.77 [28.7–33.6]; P<.001). Adjusting for gestational age at admission, the association between meeting ACOG criteria and delivering on initial admission was OR 9.96 (95% CI 4.62–21.29; P<.001).

CONCLUSION:
ACOG criteria for PTL are frequently ignored when admitting patients. Stricter adherence could reduce unnecessary admissions and costs.
Impact of Provider Gender on Patient Engagement With Prenatal Mental Health Care [31K]
Authors: Prescott Jessica E. , Valji Farida , Nguyen Diem-Tran , Sobrinho Giovanna , Ihenacho Ugonna , Dossett Emily C. 
Published: April 2018

INTRODUCTION:
Perinatal psychiatric disorders affect up to 20% of pregnant women, and are especially prevalent among women of lower socioeconomic status and women who have experienced intimate partner violence (IPV). Here we evaluate the association between provider gender and engagement with mental health care during pregnancy in a group of women seeking care at a safety net hospital.

METHODS:
This analysis includes retrospectively abstracted clinical data from patients referred to the Obstetrics Mental Health Clinic (OBMH) at a large urban county hospital between July 1, 2014 and September 1, 2016. The OBMH Clinic receives referrals from prenatal care providers and social workers for pregnant women with comorbid psychiatric symptoms. Included in the study were pregnant women, ages 18 and older, who had attended an OBMH intake interview. OBMH adherence was defined as attending at least one follow-up appointment during pregnancy after initial intake.

RESULTS:
One hundred thirty-seven patients met study criteria and were included in this analysis. There was no significant difference in OBMH adherence for women seeing a male versus a female psychiatric provider for their intake interview (χ2=2.39, df=1, P=.122). Among women with a diagnosis of posttraumatic stress disorder secondary to IPV, there was no significant association between OBMH adherence and provider gender (χ2=.084, df=1, P=.77).

CONCLUSION:
Provider gender is not a statistically significant predictor of adherence to OB mental health care. Findings suggest that women could benefit from longitudinal prenatal mental healthcare regardless of the gender of their mental health care provider.
Implementation of the ALPs Trial Into the Clinical Setting [36K]
Authors: Lauder Jhenette , Ruhstaller Kelly , Jain Vanita , Sciscione Anthony 
Published: April 2018

INTRODUCTION:
With the advent of the antenatal late preterm steroids trial (ALPS), clinical practice patterns have changed. We sought to determine our hospital's rate of adherence to the ALPS protocol in the first year since its implementation.

METHODS:
This is a retrospective cohort study of all late preterm, singleton deliveries in our academic, tertiary care facility from March 1, 2016 to February 28, 2017. Exclusions included aneuploidy and major fetal anomalies. The primary outcome was the appropriate implementation of ALPS, including the identification of ineligible patients. Patients were divided based on delivery in the first or second half of the year. Secondary outcomes included maternal and neonatal outcomes. Data was analyzed as intention-to-treat. Student's t-test, χ2, and univariable logistic regression were utilized for analysis.

RESULTS:
Four hundred seven women with singleton pregnancies delivered in the late preterm period, and 393 were eligible for analysis. No significant differences were noted in demographic or clinical characteristics, including race, parity, admitting service, delivery indication, delivery mode, or birth weight between women who delivered in the first or second half of the year (all P>.05). In the year following adoption of ALPs, there was a significant improvement in the identification and implementation of the protocol (61.8% versus 79.2%, P<.01). There was a trend towards improved neonatal outcomes. However, likely due to the small sample size, it did not reach statistical significance.

CONCLUSION:
Implementation of ALPS improved over the first year following its adoption in our institution. However, 1 in 5 women were inappropriately managed. A strategy for increasing adherence to the ALPS protocol is needed.
Estimated Fetal Weight Accuracy in Macrosomic Fetuses Versus Fetuses of Normal Weight [37K]
Authors: Holloman Conisha , Kostamo Kathryne , Bahamon Camila , Mcwhorter Jeannie , Jodicke Cristiano , Carlan Stephen 
Published: April 2018

INTRODUCTION:
The purpose of this study is to compare the accuracy of estimated fetal weight (EFW) between those fetuses with EFW >90 percentile and those with EFW less than or equal to 90 percentile.

METHODS:
Retrospective study of all pregnant women from January 2010 to September 2013 who had an ultrasound (US) and delivered within a week. Group 1=EFW >90 percentile for gestational age. Group 2=EFW <or equal to 90 percentile. Primary outcome included birth weight (BW) at delivery. Secondary outcomes included cesarean section (CS) and induction rate. Statistical analysis included χ2 and student t-test for categorical and continuous variables, respectively.

RESULTS:
Group 1=133 cases and Group 2=930 cases. There were no significant differences in age, race/ethnicity and gravidity status between the two groups. Class II (23% versus 14%) and III (26% versus 16%) obesity, EGA at scan (39.0±1.5 versus 38.3±2.0 weeks) and delivery (39.3±1.5 versus 38.0±1.9 weeks), CS rate (65% versus 41%), EFW by US (4,042±330 versus 3,057±518 g), birth weight (3,848±404 versus 2,972±517 g) and weight difference (−194±302 versus −85±241 g) were noted to be higher in group 1 (P<.05). Induction of labor rate (23% versus 32%) was higher in group 2.

CONCLUSION:
The accuracy of US generated EFW is an important factor in determining route of delivery. Our data suggests that the larger the EFW by US the greater the chance of error when compared to the BW of smaller infants.
Evaluating Patient Satisfaction and Experience for Technology-Enabled Prenatal Care for Low Risk Women [1L]
Authors: DeNicola Nathaniel , Sheth Sheetal , Leggett Kelly , Woodland Mark B. , Ganju Nihar , Marko Kathryn 
Published: April 2018

INTRODUCTION:
Telemedicine and connected health has the potential to remodel prenatal care by enabling more frequent contact and increased patient engagement. This study sought to measure patient satisfaction in low-risk pregnant women who used an integrated mobile platform to supplement prenatal care.

METHODS:
Five hundred ninety-five surveys were administered to low-risk pregnant women enrolled in the Babyscripts (BRx) program, an integrated technology platform including a mobile application and connected devices (weight scale and blood pressure cuff). A 15-question survey was administered to gauge participant satisfaction in the mobile app, pregnancy readiness, relationship to the healthcare team, patient perception of saved time in the clinic, ease of use and educational content. Metrics were analyzed as percent of the total possible score.

RESULTS:
Among 131 respondents (22% response rate) overall patient satisfaction measured high, ranging 85%–95% (agree/strongly agree) in remote monitoring, 82%–88% with the mobile app, 77%–85% for pregnancy readiness, and 83%–90% in their relationship with the healthcare team. Ninety-three percent of respondents agreed that BRx saved time in the clinic. The mobile app was rated as “easy to use” by 86%, with a 93% and 75% ease of use rating for the weight scale and blood pressure monitor, respectively. The educational value of the app was also highly rated at 84%.

CONCLUSION:
Patient satisfaction with the mobile connected health platform was high. These findings support the integration of connected health platforms in low-risk pregnancies. This study suggests potential for connected health to improve value-based clinical outcomes, which can be explored with future research.
Analysis of Joint Outpatient Experience Survey in Obstetric Populations in Military Health Care System [6L]
Authors: Warner Steven , Tobler Kyle , Parker Jason 
Published: April 2018

INTRODUCTION:
In the military, patient satisfaction is measured using the Joint Outpatient Experience Survey (JOES). It unclear if the measures used in the JOES survey represent actual patient concerns. The aim of this study was to determine if the measures included in the JOES survey are valued by the patients.

METHODS:
Obstetric patients in a community hospital clinic with excess of 30,000 clinic visits a year were given an anonymous questionnaire to evaluate patient priorities related to care received within an obstetrics clinic. This survey queried patients on the value they placed on the primary characteristics directly measured by the JOES survey.

RESULTS:
The survey included 73% response rate over one week of routine visits. Respondents noted significant desire for obstetrical ultrasound at each visit, a strong desire to see the same provider, and a desire for 24 hours access to the provider. Patients strongly desired an obstetric facility to recommend to friends and family. When questions were grouped and ranked, these obstetric questions were viewed as more important to the respondents than standard survey questions as measured by the JOES survey.

CONCLUSION:
This study demonstrates findings not previously reported regarding the unique characteristics most valued by obstetric patients in a military setting. JOES survey is adequate in measuring patient satisfaction, though obstetric specific metrics appear to more greatly influence patients' satisfaction when compared to the standard JOES survey questions. These results question the need for a broader measure of patient satisfaction in the military setting when evaluating obstetric encounters.
Obstetrician-Gynecologist Perceptions of Patient and Employer Gender Discrimination [7L]
Authors: Turrentine Mark , Ramirez Mildred , Stark L. M. , Snead Carrie , Schulkin Jay 
Published: April 2018

INTRODUCTION:
To evaluate if obstetrician-gynecologists (ob-gyn) perceive discrimination from patients and organizational gender-preferences.

METHODS:
Two large private practice ob-gyn groups anonymously surveyed physicians to explore if patients' and employers' preferences of gender influenced selecting an ob-gyn, impacted their clinical practice, and resulted in feelings of discrimination. The Mann-Whitney U test was utilized for comparisons.

RESULTS:
In 2017, 35 physicians were surveyed (with a 97% response rate), 24 females and 10 males. Male physicians were older (52 versus 44 years, P<.01) and in practice longer (17 versus 11 years, P=.03), but no differences in race/ethnicity, sexual orientation, or board certification. Female and male physicians agreed that patient's preference for the gender of her physician is her first priority (42% versus 50%, respectively, P=.14). Male physicians agreed that their gender has negatively impacted their patient practice volume (60%); whereas female physicians disagreed with this statement (96%), P<.01. Male physicians agreed that they were discriminated against by patients due to their gender (40%); whereas female physicians disagreed (88%; P=.01). Similarly, 50% of male compared to 17% of female physicians felt discriminated against by their employer due to their gender, although this was not significant (P=.20). However, female physicians felt they were discriminated against due to gender in terms of salary (46%) compared to male physicians (20%), P=.049.

CONCLUSION:
Female and male ob-gyns perceive gender-discrimination; however, the former is due to compensation and the latter is due to patient preferences.
Predictive Cutoffs of 1-Hour GCT Prior to 16 Weeks in Diagnosing Carbohydrate Intolerance in Early Gestation [36L]
Authors: Khan Rana , Sholle Evan , Razavi Armin , Gelber Shari E. 
Published: April 2018

INTRODUCTION:
Early pregnancy screening for undiagnosed type 2 diabetes (DM) is commonly performed using the same criteria used at mid-gestation. However, characteristics of early GCT have not been well described. We compared the predictive values of different cutoffs of early versus late GCT.

METHODS:
Single center retrospective cohort study of women with a positive 1-hour GCT (>130 mg/dL) prior to 16 weeks gestation (eGCT) or between 24 and 28 weeks of gestation (lGCT). eGCT was performed in high-risk patients. All women with a positive GCT received a 3-hour glucose tolerance test (GTT). Carpenter-Coustan criteria were used to diagnose DM. Sensitivity and specificity were calculated for eGCT and lGCT cutoffs from 130 to 195 mg/dL.

RESULTS:
Three thousand two hundred seventy-one women met study criteria, of whom 228 received eGCT and 3,043 received lGCT. Overall prevalence of GDM was 18% (23% early diagnosis, 17% late diagnosis). The sensitivity and specificity were (cutoff: sensitivity/specificity; eGCT versus lGCT) 130: 100%/1%, versus 99%/1%; 135: 98%/8%, versus 96%/12%; 140: 92%/21% versus 87%/31%; 150: 73%/49% versus 66%/62%. Sensitivity and specificity of eGCT to predict mid-gestation GDM diagnosis were 130: 100%/0%; 135: 94%/11%; 140: 90%/24%; 150: 68%/52%; 160: 35%/83%; 170: 10%/91%; 180: 3%/97%; 185: 0%/100%.

CONCLUSION:
Similar to the lGCT, eGCT cutoffs of 130–140 mg/dL have high sensitivity with poor specificity. For patients without early diagnosis of DM, an eGCT cutoff >180 is highly predictive of mid-gestation GDM. Given the poor specificity, other screening tests such as 2-hour GTT or standard screening combined with HgBA1C could be studied as alternatives.
Emergency physician evaluation of PA and NP practice patterns
Authors: Phillips Andrew W. , Klauer Kevin M. , Kessler Chad S. 
Published: April 2018

ABSTRACT
The unprecedented surge in physician assistants (PAs) and NPs in the ED developed quickly in recent years, but scope of practice and practice patterns are not well described.

Methods:
We conducted two cross-sectional electronic surveys of the American College of Emergency Physicians' council. Survey construction was informed by interviews and evaluated with validity and reliability studies. Univariate analyses to establish associations also were performed.

Results:
Most councilors' departments employ PAs and NPs (72.4% of 163 responses). Supervisory requirements varied greatly among respondents for the same emergency severity index (ESI) level. Regardless of experience level, NPs were reported to use significantly more resources than PAs; chi-square(4) = 105.292, P < .001 for less-experienced PAs or NPs; chi-square(4) = 120.415, P < .001 for more experienced PAs or NPs.

Conclusion:
Councilors reported great variation in PA and NP scope of practice. The results also suggest that new graduate PAs may be more clinically prepared to practice in the ED than new graduate NPs.
The effects of probiotics on mood and emotion
Authors: Kane Lindsey , Kinzel Julie 
Published: April 2018

ABSTRACT
Preliminary research in humans and rodents demonstrates that various probiotic formulations of Lactobacillus and Bifidobacterium have a clinical and neurochemical anxiolytic effect on the central nervous system (CNS). Further research is warranted to more extensively examine the theorized connection between the gastrointestinal tract and the CNS; however, initial evidence suggests probiotics affect various mechanisms of the gut-brain connection that modulate anxiety-like behaviors. This article describes the wider-reaching effects of probiotics, specifically related to behavior and brain function.
New Treatment for BRCA-Mutated Metastatic Breast Cancer
Authors: Aschenbrenner Diane S. 
Published: April 2018

Lynparza (olaparib tablets) is now approved for the treatment of inherited BRCA-mutated, human epidermal growth factor receptor 2–negative metastatic breast cancer.Drugs and other substances that greatly increase or decrease the activity of the cytochrome P-450 (CYP) isoenzyme CYP3A should be avoided when taking Lynparza.
Reports of Anaphylaxis with an Antiemetic
Authors: Aschenbrenner Diane S. 
Published: April 2018

The labeling for rolapitant (Varubi), an antiemetic used with chemotherapy, will now include a safety warning stating that the drug can cause anaphylaxis and serious hypersensitivity reactions.Nurses should assess patients for hypersensitivity to any of the drug's components prior to administration.
Contraception/Family Planning Are Centering Pregnancy Patients More Likely Than Traditional Care Patients to Select LARC? [1F]
Authors: Roussos-Ross Dikea , Prieto Autumn , Watson Amelia K. , Goodin Amie 
Published: April 2018

INTRODUCTION:
Postpartum contraception is an integral part of a woman's medical care. Adequate counseling may not always occur prenatally, leaving the woman without a contraceptive plan postpartum. CenteringPregnancy (CP) focuses an entire session on contraceptive options. We investigated whether CP patients were more likely than Traditional Care (TC) patients to desire contraception, and more specifically LARC.

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 used significantly more postpartum contraception (85.16% vs. 75.73%; p=0.039) and specifically more LARC (36.80% vs. 20.39%; p=0.001) than traditional care patients. After controlling for patient characteristics, CP patients were 2.02 times more likely to utilize LARC than TC patients (95% CI: 1.17-3.50).

CONCLUSION:
Patients enrolled in CP are more likely to utilize postpartum contraception and specifically LARC. It is possible that the increased discussion within the group setting, and the knowledge that peers are selecting contraceptive methods, may motivate patients to desire postpartum contraception. Further investigation would be necessary to determine if these findings are reproducible.