bluuebunny/crossref_metadata_2025_split huggingface dataset:
Medical Student Perceptions Regarding Students Performing Pelvic Examinations on Anesthetized Female Patients [20N]
Authors: Rice Elizabeth , White Chase , Myers John , Ko Janet , Jaspan David , Goldberg Jay 
Published: May 2019

INTRODUCTION:
The purpose of this study was to determine perceptions of medical students regarding their peers performing pelvic examinations on anesthetized female patients.

METHODS:
A survey was distributed to medical students at multiple medical schools. Demographic data were collected. Non-demographic answers to questions were recorded on a 5-point scale. Characteristics between the respondent groups were statistically compared using Chi-squared test for independence and the Fisher's Exact Test.

RESULTS:
220 medical students completed the questionnaire. 77% of medical students believed permission should be obtained from patients before the performance of pelvic examinations by medical students on anesthetized patients. Only 30% of respondents believed prior consent was usually obtained. 46% believed patients would agree to have EUAs performed. 85% of medical students believed patients would be upset if they were made aware a pelvic examination by a medical student had been performed without their prior consent. 60% of medical students believed medical students should be allowed to examine anesthetized patients. 87% of medical students believed there was educational benefit. 53% would recommend to a female relative to allow a medical student to perform a pelvic EUA on them.

CONCLUSION:
Despite the perception of medical students that consent should be obtained before they perform pelvic examinations on anesthetized female patients, this does not usually occur. Almost 50% of medical students would not encourage their female relatives to consent to medical students performing pelvic examinations. There was no statistical difference between male and female medical students regarding perceptions of student pelvic examinations on anesthetized female patients.
MAMA's Risk Stratified, Prenatal Medical Home Model Reduces Preterm Birth for African Americans in LA [22N]
Authors: Scibetta Emily , Greenwell Lisa , Moini Moraya , Jackson Ashaki , Trang Cassandra , Saleeby Erin 
Published: May 2019

INTRODUCTION:
MAMA'S Neighborhood (MAMA's) in LA County (LAC) organizes prenatal care into a medical home model of wrap-around services. African American (AA) women are 48% more likely to experience PTB than non-Hispanic whites and experience myriad social stressors; MAMA's was designed to support women experiencing such stressors to reduce PTB risk. MAMA's implemented risk assessments at intake for behavioral health, substance use, housing/food insecurity and medical risk; and stratified risk groups to direct levels of care management and services to address these risks.

METHODS:
This is a retrospective cohort study, using single site data from a national demonstration project, to compare PTB rates for women in LAC during two phases: Phase 1: January 2014-August 2015, MAMA's introduced a novel risk assessment for social stressors and Phase 2: September 2015-December 2016, implemented risk-stratified population health management and individualized care planning. Multiple births were excluded. Multivariate logistic regression was performed and controlled for: medical comorbidities, smoking, race/ethnicity, age and prior PTB.

RESULTS:
Phase 1 included 441 women, compared to 435 in Phase 2. PTB among AA women dropped from 18% in Phase 1 to 9% in Phase 2. Regression reveals PTB among AA women was reduced when compared to controls with an adjusted odds ratio of 0.21 (CI 0.062-0.708), p<0.02.

CONCLUSION:
MAMA's made a clinically and statistically significant impact on PTB for AA women, a critical step in addressing the health equity gap. MAMA's represents a promising value-based strategy leveraging multidisciplinary collaborative care with existing social services in the safety net to improve birth outcomes.
Maternity Leave Length Impact on Breastfeeding and Postpartum Depression [29N]
Authors: Shumbusho Diane I. , Keyser Erin A. 
Published: May 2019

INTRODUCTION:
To determine the impact of maternity leave length on breastfeeding duration and postpartum depression rates in active duty service members.

METHODS:
An IRB approved survey of nine questions was given to patients at the Brooke Army Medical Center Obstetrics and Gynecology clinic. Patients were offered voluntary participation if they had delivered a baby while on active duty in the preceding 20 years. The survey included questions about length of maternity leave, duration of breastfeeding, age at delivery, route of delivery, and whether the patient suffered from postpartum depression.

RESULTS:
A total of 214 surveys were collected. Fisher's exact test was used to compare rates of breastfeeding and postpartum depression between the two groups. 87% of service members initiated breastfeeding. Among women who had 6 weeks versus 12 weeks of maternity leave, 51.64% versus 56.96% breastfed up to 6 months, p=0.45. The overall rate of postpartum depression was 13.5%. Among women who had 6 weeks versus 12 weeks of maternity leave, 16.1% versus 9.5% reported postpartum depression, p=0.11.

CONCLUSION:
The ideal maternity leave duration is unknown. With the recent change in the Department of Defense maternity leave policy, we aimed to evaluate the impact this had on breastfeeding and postpartum depression rates. No statistical difference was seen when we compared rates of breastfeeding and postpartum depression in women who had 6 versus 12 weeks of maternity leave. Further research is required to determine the ideal maternity leave duration and best practices to promote breastfeeding and diminish postpartum depression.
Establishing New Diagnostic Criteria for Early Gestational Diabetes Screening [30N]
Authors: Loehr Frederick W. , Mackeen Awathif D. , Paglia Michael J. , Nordberg Cara 
Published: May 2019

INTRODUCTION:
Cutoff values for the one-hour, 50-g glucose test (Glucola) in early pregnancy are based on data from studies at 24-28 weeks. A value of 200 mg/dL is often used to give a diagnosis of GDM without further testing. The aim of this study was to establish a lower cutoff for the early Glucola over which women should receive an immediate diagnosis of GDM.

METHODS:
In this IRB-approved retrospective cohort study, the electronic medical records in the Geisinger system were searched between 1/1/2010 and 12/31/2016 for all women who had completed a Glucola prior to 20 weeks and all subsequent indicated testing. Women with a result of 130-199 mg/dL on the early Glucola went on to complete a three-hour 100-g glucose tolerance test. Women who were not diagnosed with GDM on early screening underwent routine screening after 24 weeks. The risk of developing GDM for a given early Glucola result was analyzed to identify another, potentially lower level, above which women should receive an immediate diagnosis of GDM without further testing.

RESULTS:
There were 3040 women identified as having completed an early Glucola and 631 women had a result between 130 and 199 mg/dL. 125 women were diagnosed with GDM at some point in the pregnancy. Increasing values for the early Glucola trended towards higher positive predictive values as would be expected. However, the positive predictive value never surpassed 32.4%.

CONCLUSION:
A change in practice where a lower glucose level is used to diagnose GDM from the early Glucola is currently not supported.
Mode of Delivery Among Physicians Practicing at a Teaching Hospital, Northern Ethiopia [34N]
Authors: Teka Hale , Yeman Awol , Hasan Abida , Ahmed Sumeya , Abate Ermias 
Published: May 2019

INTRODUCTION:
The Ethiopian national cesarean section rate is about 2%, but rates of cesarean delivery (CD) vary widely among population segments suggesting unequal access. Within this context, the aim of this study was to assess the mode of delivery among physicians employed at Ayder Comprehensive Specialized Hospital.

METHODS:
This is an IRB-approved cross-sectional study. All female physicians who are parous (n = 11) and all male physicians whose spouses are parous (n = 60) were interviewed to evaluate the mode of delivery among them, and assess indications for CD.

RESULTS:
The CD rate among physicians and their spouses was 46.5% (n=33). 9 out of 10 female obstetrician/gynecologists and male obstetrician/gynecologists' spouses delivered via CD. Of those who had their baby delivered via CD, 22 (67%) believe that the CD was not done for appropriate indications. Only 10 (30%) of these would try labor or allow their spouse to attempt vaginal trial of labor after prior CD. The driving factors for CD among parturient physicians were; lack of trust in the process of intrapartum fetal monitoring (which is used without pattern interpretation), “uncertainty” of outcome of vaginal delivery, fear of labor pain (due to absence of labor analgesia), and managing obstetricians' fear of blame by their colleagues.

CONCLUSION:
This study revealed a disparity in CD for women who are physicians or physicians' spouses Vs general population. More revealing are the reasons why they underwent CD. Rate of CD may be decreased by winning the confidence of parturients through instituting appropriate intrapartum fetal monitoring and labor analgesia protocols.
Mommy Meltdown: A Look at the Prevalence of Postpartum Depression and Attitudes Towards Treatment Guidance [35N]
Authors: House Talelia , Spiryda Lisa Beth 
Published: May 2019

INTRODUCTION:
One in seven women are affected by perinatal depression. Black and Hispanic women are amongst those affected the most, which has been said be influenced by socioeconomic and emotional disadvantage. The goal of this study is to determine the prevalence of postpartum depression (PPD) and look at the attitudes of minority women toward depression and treatment considerations.

METHODS:
This study is a prospective survey that was completed at the six week postpartum In addition to the Edinburgh Postnatal Depression Scale. All 18 years old and older and less than 8 weeks postpartum were invited to complete the survey. The primary outcome of our study is prevalence and attitudes toward depression.

RESULTS:
Our preliminary results show that approximately 20% of our patient population suffer from postpartum depression based on EPDS scores (Median Score: 8; Range 0-25). 40% of our patients identified as Black. There was no difference in EPDS score when data stratified by race, mode of delivery, NICU stay and complications of pregnancy. Regardless of race, patients were also open to treatment for PPD and feel comfortable discussing the topic with their families.

CONCLUSION:
PPD was common among our patient regardless of race. Both black and white women were open to discussing depression with their families and willing to accept treatment. By identifying the prevalence of PPD and attitudes toward depression and treatment, we are hoping to shed light on the growing epidemic in minority patients and move toward eliminating health disparities in mental health in our moms and moms-to-be.
More Blood Transfusions for Rural Women Delivering Low Risk Infants in the United States [37N]
Authors: Hartenbach Ellen , Hsiang-Hui Daphne Kuo , Greene Madelyne , Shrider Emily , Antony Kathleen M. , Ehrenthal Deborah 
Published: May 2019

INTRODUCTION:
Maternal morbidity and mortality is on the rise in the United States. We sought to assess outcomes for women who live in rural areas.

METHODS:
We used 2014-2015 geocoded birth records from the National Center for Health Statistics (NCHS) to examine the rural-urban differences in blood transfusion among nulliparous women delivering singleton, vertex pregnancies at term. We compared transfusion rates across maternal county of residence defined by the six NCHS geographic categories. We conducted multivariable logistic regressions controlling for maternal age, race/ethnicity, nativity, education, WIC participation, insurance, prenatal care, BMI, pre-existing diabetes and hypertension, hepatitis, tobacco use during pregnancy, mode of delivery, gestational age and birthweight. Data were obtained through a data use agreement; the study was declared exempt by our Institutional Review Board.

RESULTS:
Among 2,538,994 eligible births, transfusion rates increased across the geographic categories from more urban to rural: large metropolitan-center (2.0 per 1,000 live births), large metropolitan-fringe (2.5), medium metropolitan (2.5), small metropolitan (2.6), micropolitan (4.6), and non-core/rural area (5.3). After adjusting for covariates, the odds of transfusion was higher among women living in rural (adjusted odds ratio 2.70, 95% CI 2.44-2.98) and micropolitan (adjusted odds ratio 2.39, 95% CI 2.19-2.61) counties when compared to women living in large central metropolitan counties.

CONCLUSION:
Our results suggest that the odds of blood transfusion is higher for women living in rural and micropolitan counties than those living in more urban settings. This may indicate rural-urban disparities in maternity health care access and quality and warrants further investigation.
Usability of Virtual Reality for Anxiety Reduction During First Trimester Dilation & Curettage: A Qualitative Study [5A]
Authors: Woodson Ryan , Zhang Shiliang , Sridhar Aparna 
Published: May 2019

INTRODUCTION:
Recent innovation in virtual reality (VR) has generated increased interest in its potential use as an innovative and non-invasive method for managing patient anxiety and subsequently decreasing acute pain. We assessed the ability of immersive VR and its impact on perceived anxiety and pain among women presenting for a first-trimester in office surgical abortion.

METHODS:
Using purposive sampling methods, we recruited 15 women presenting for a first trimester surgical abortion. Participants were given a commercially available VR device to wear during the procedure. In-depth interviews were conducted post-surgery with participants to understand their experience using the VR device and any impact it had on their perceived anxiety and pain. The interviews were recorded, transcribed, and analyzed using grounded theory via Dedoose.

RESULTS:
Fourteen out of fifteen participants stated the VR device lessened their anxiety during the procedure. Described as a “distraction,” the VR experience helped participants to “feel calm and less anxious” during and even after the procedure. Six participants removed the device at some point during the procedure due to reasons related to pain, nausea, and a desire of wanting to see the procedure. Nine out of fifteen participants reported the VR device helped with pain reduction during the procedure.

CONCLUSION:
The results of this feasibility study suggest the potential for VR use and its three-dimensional experiences can help reduce perceived anxiety and pain among women undergoing a first trimester surgical abortion. Future studies will use these findings to elucidate VR's potential effect on anxiety and pain with experimental studies.
Male Hormonal Contraceptive Safety: A Systematic Review of Adverse Events Across Investigational Methods [6A]
Authors: Franks Jennifer M. , Nguyen Brian T. , Dinalo Jen 
Published: May 2019

INTRODUCTION:
Clinical trials of novel male hormonal contraceptives (MHCs) promise effective methods that may decrease global unmet needs for contraception. However, concerns about potential harms may influence uptake and impede development. No review has systematically documented the range and frequency of MHC-related adverse.

METHODS:
We searched OvidSP, Medline, Embase, Cochrane Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry Platform for MHC clinical trials through 2017 (N=2,080). MHCs are defined by their expected action on steroid receptors to suppress spermatogenesis to contraceptive effect, while maintaining normal androgen levels. Trials were limited to those with >8 weeks of exposure and >30 participants. Considerations for the detection of adverse events and measurement of harms were identified; bias was independently evaluated and reported in accordance with PRISMA-harms guidelines.

RESULTS:
Twelve trials collectively enrolled more than three thousand participants, with median exposure of 52 weeks. Trials consistently noted significant decreases in HDL, increases in hemoglobin, increases in body weight, and decreases in testicular volume. 26 serious adverse events were reported; only 3 were considered possibly MHC-related (depression, suicide attempt, atrial fibrillation). Likely-related adverse events included acne, non-specific mood changes, and increased/decreased libido; screening and measurement of these outcomes was inconsistent across trials. Discontinuations for these events were uncommon.

CONCLUSION:
Long-term data are needed to determine the influence of MHCs on cardiovascular/metabolic risk. However, early MHC trials suggest the absence of serious harm for up to one year of use among healthy men. Future research should routinely incorporate standardized measures of mood and sexual function.
Effects of Protocol Changes on Postpartum Visit Attendance Rates and Patient Care at a Student-run Free Clinic [7A]
Authors: Rosenberger Marie , Fagan Taylor , Heil Cate , Calkins John William 
Published: May 2019

INTRODUCTION:
The recommended 4-6 weeks postpartum visit is critical for mothers, however, 40% do not attend.1 Postpartum guidelines by American College of Obstetricians and Gynecologists (ACOG) are widely used, but based on observation and expert opinion.1 This study aims to determine effectiveness of new postpartum protocol using ACOG guidelines at a student-run free clinic. This study provides insight into effective strategies for this type of clinic.

METHODS:
Patients at JayDoc Free Clinic who delivered from 4/1/2014 to 10/31/2017 were included. IRB approval obtained. Patients managed prior to protocol implementation (Group 1; N=31), compared to patients managed using new JayDoc Free Clinic protocol (Group 2; N=44). The new protocol changes included scheduling postpartum appointments before delivery, appointing a postpartum liaison, and calling the patient after delivery and 1 day prior to appointment. Analysis performed using statistical package R and X2-statistics. Primary outcome was postpartum visit attendance rates, secondary outcomes included depression screening and contraception.

RESULTS:
Implementation of protocol led to an increase in scheduling postpartum appointments to 97.72% from 51.6% prior to implementation (X2 (1, N=75)=22.52, p<.01). Attendance was 69.38% of new protocol patients, compared to 61.5% in Group 1 (X2 (1, N=75)=5.4853, p<0.02). Group 2 increased LARC use to 51.16% from 23.08% (X2 (1, N=69)=4.20, p<0.05) and increased depression screening 79.07% from 52.17% when compared to Group 1 (X2 (1, N=66)=4.20, p<0.05).

CONCLUSION:
Implementation of new postpartum protocol demonstrated improved scheduling and attendance. The addition of an official protocol also helped ensure patients discussed contraception options and postpartum depression. Overall, the introduction of postpartum protocol modeled after ACOG guidelines enabled the student-run free clinic to improve processing and patient care, which resulted in attendance above the national average.
Team-Based Communication Increases Adherence to Suggested Decision-to-Incision Times in an Urban County Hospital [8A]
Authors: Cheeks Morgan , Habrylo Ireneusz , Brandon Kelly , Malekmadani Arienne , Yemane Hannah , Newmann Sara J. 
Published: May 2019

INTRODUCTION:
Decision-to-Incision (DTI) research has investigated maternal and neonatal outcomes, while literature on decreasing DTI times remains sparse. Here we describe a quality improvement project, led by first-year medical students, aimed at reducing DTI times at a county hospital using a worksheet to guide communication during interdisciplinary huddles before each unplanned cesarean.

METHODS:
In 2017, medical students at Zuckerberg San Francisco General Hospital implemented a grading system to standardize the urgency of unplanned cesareans and interdisciplinary DTI huddles to assign target incision times for cesareans. Our initial intervention provided checklists for each team member. Following interviews with staff, we developed a printed communication tool to facilitate discussion around urgency, potential delays, and target incision time. Using worksheet and medical record data, we analyzed use of the DTI communication tool and DTI times pre-intervention (June-August 2016), post-checklist implementation (February-August 2017) and post-communication tool implementation (March-August 2018).

RESULTS:
Use of the DTI workflow in unplanned cesareans more than doubled from 20.2% to 47.7% after switching from checklists (n=74) to the communication tool (n=86). Mean DTI time decreased from 93 to 82 minutes during the same time period. Following implementation of the tool, 52.5% of unplanned cesareans occurred within five minutes of the suggested DTI times for each grade, and we observed a significant effect of urgency grade on DTI time [F(2,47)=11.3, P<.001].

CONCLUSION:
The grading system adequately stratified the urgency of cesareans, while the communication tool streamlined discussion of potential delays. Guided interdisciplinary communication, not just checklists, facilitates team-based interactions critical to decreasing DTI times.
Vasa Previa: A New Paradigm in Patient Hospitalization, Timing of Delivery and Corticosteroid Use [11A]
Authors: Villani Linda A. , Al Torshi Rashida , Shah Prakesh S. , D'Souza Rohan D. , Kingdom John C. , Keunen Johannes 
Published: May 2019

INTRODUCTION:
Vasa Previa occurs when fetally-derived umbilical cord vessels cross the internal os of the cervix. The aim of this study was to evaluate parameters that influence outpatient versus inpatient management in these cases.

METHODS:
Research Ethics Board approval was obtained for this study. Consecutive cases of vasa previa as diagnosed at Mount Sinai Hospital, Toronto from January 2008 to December 2017 were retrospectively reviewed. Cases were categorized into 3 arms for analysis: outpatients (OP), indicated hospitalized (IH) and non-indicated hospitalized (NIH). The NIH arm included asymptomatic patients admitted for surveillance, while the IH arm included symptomatic patients admitted for antepartum hemorrhage.

RESULTS:
84 cases of vasa previa were diagnosed during the study period. The IH group was admitted a median of 22.5 days longer vs the NIH group up to delivery. The IH group had the highest frequency of unplanned caesareans at 46.2%, vs 7.1% and 11.1% of cases in the NIH and OP groups, respectively. Despite having an equal number of unplanned caesareans, the NIH group delivered a median 1.7 weeks earlier vs the OP group (P=.0040). NIH patients were also more than twice as likely to receive corticosteroid therapy inappropriately vs the OP group (57.1% vs 27.8%, P=.0359). A median (IQR) of 5 (3.5-7.6) weeks between corticosteroid administration and delivery existed among patients who received this therapy inappropriately.

CONCLUSION:
Our evidence suggests that physicians have difficulty predicting imminent preterm delivery for proper corticosteroid use in this population, but may be able to offer asymptomatic patients the option of outpatient management.