bluuebunny/crossref_metadata_2025_split huggingface dataset:
Lower Urinary Tract and Pelvic Floor Symptoms and their Correlation with Fibroid Characteristics [39M]
Authors: Shaffer Robyn K. , Dobberfuhl Amy D. , Fast Angela M. , Vu Kim-Nhiem , Ghanouni Pejman , Chen Bertha 
Published: April 2018

INTRODUCTION:
Lower urinary tract symptoms (LUTS) are prevalent in women with uterine fibroids. Research suggests that increased fibroid volume and uterine bulk is associated with more severe LUTS and pelvic floor symptoms, however the correlation between fibroid size/location, adenomyosis, and symptoms has been under-studied. We sought to investigate this correlation using MRI which provides detailed information on fibroid characteristics.

METHODS:
A retrospective chart review was conducted for patients seen at the Stanford Fibroid Clinic. Patient demographics, medical history and pelvic MRI data were collected on 60 patients with completed Uterine Fibroid Symptom (UFS) and Pelvic Floor Distress Inventory (PFDI) validated symptom surveys. Primary outcome was scaled symptom scores and sub-scores including the Urogenital Distress Inventory (UDI-6).

RESULTS:
Dominant fibroid volume correlated negatively with urinary frequency (r=-0.307, P=.030), urgency (r=−0.287, P=.043), and pelvic pain or discomfort (r=-0.281, P=.049). Longest fibroid dimension also negatively correlated with UDI-6 (r=-0.304, P=.028). Number of fibroids and uterine volume were not significantly associated with LUTS. However, higher PFDI score was significantly associated with presence of adenomyosis on MRI (mean 82.9 vs 159.6, P=.018) and serosal fibroid location (mean 139.3 vs 69.0, P=.011). Patient BMI correlated positively with UDI-6 (r=0.415, P=.002) and PFDI (r=0.371, P=.005).

CONCLUSION:
Contrary to common belief, dominant fibroid size was inversely associated with LUTS, suggesting that fibroid dimensions may not predict bulk-related symptom severity. Adenomyosis should be considered in the evaluation of LUTS in women with uterine fibroids. In accordance with current literature, BMI is associated with LUTS including incontinence, urgency, and frequency.
The Relationship Between Internalized HIV Stigma and Risky Sexual Behavior [1N]
Authors: Jones Solita , Konkle-Parker Deborah , Blackshear Chad 
Published: April 2018

INTRODUCTION:
HIV stigma marginalizes HIV-infected individuals from society. Twenty-five percent of people living with HIV are women. Because stigma and discrimination could impact the willingness of a person to disclose their HIV status to their sexual partner; it would be valuable to know how much stigma is associated with unprotected sexual behavior in women and the willingness to disclose their status.

METHODS:
Data were collected through Women’s Interagency HIV Study (WIHS), a longitudinal cohort study started in 1993 of women living with HIV (WLWH) or at risk for HIV, with questions asked from April to October 2015. The relationships between HIV stigma and risky sexual behavior were analyzed using Wilcoxon rank-sum test.

RESULTS:
Among 2022 participants, 1654 (70%) were HIV positive and 453 (20%) of participants were legally/common law married. Of the HIV + participants, 389 (18%) reported engaging in risky sexual behavior defined as unprotected vaginal or anal sex. There was no statistically significant relationship between HIV disclosure rate and engagement in risky sexual behavior (p=0.119). However, those who were married reported engaging in risky sexual behavior more often than those not in committed relationships (p<.001). No relationship existed between internalized stigma and disclosure or risky sex.

CONCLUSION:
Increased internalized HIV stigma was not found to correlate with engagement in risky sexual behavior and disclosure rates amongst WIHS participants. The level of commitment among married participants may influence behavior and risk acceptance. Further analysis of viral loads, partner serostatus and disease duration in these participants is needed.
Prevalence of Abnormal Cervical And Vaginal Cytology In HIV-Infected Women Over The Age Of 65 [5N]
Authors: Stewart Kelsey , Chesnokova Arina , Syed Fatima , Levison Judy 
Published: April 2018

INTRODUCTION:
HIV-infected women are 10-11 times more likely to develop abnormal cervical cytology compared with HIV uninfected women, elevating the need for Pap smear surveillance. While guidelines for screening exist for HIV-infected women of reproductive age, there is inadequate data to guide care for women over 65. Our research evaluates the prevalence of abnormal cervical cytology/CIN and invasive neoplasia in HIV-infected women over the age of 65 with no history of abnormal Paps to aid in the creation of screening recommendations for this demographic.

METHODS:
This is a retrospective chart review of records from 2000-2015, from an urban low-income setting. We screened 254 patients, 70 of whom met inclusion criteria: HIV+, age over 65, with at least one pap test after age 65, lacking abnormal cervical/vaginal cytology screening, and lacking history of hysterectomy for non-benign reasons.

RESULTS:
Of included patients, 17.1% had at least one abnormal pap smear: 41.7% ASCUS/HPV+, 75.0% LSIL, 25.0% HSIL, with 25.0% patients having more than one abnormal result. Of those with abnormal pap, 66.7% had abnormal pathology on follow-up biopsy: 33.3% CIN/VAIN1, 16.7% CIN/VAIN2, 16.7% CIN/VAIN3. No patients had invasive cancer. Median time to first pap test after age 65 was 14.7 months. No demographic factors were significantly associated with abnormal pap. Higher viral load at time of testing was positively associated with abnormal pap.

CONCLUSION:
Our findings of high rates of abnormal pap tests and subsequent high rates of abnormal pathology suggest that pap tests in women over age 65 may be indicated.
Postoperative Opioid Use After Cesarean Delivery [15N]
Authors: Lawlor Megan , McQuerry Kristen J. , Tan Jenny , Williams Corrine M. , Hansen Wendy , Critchfield Agatha S. 
Published: April 2018

INTRODUCTION:
To investigate patterns of use and optimal prescribing of post-operative outpatient opioids for pain control after cesarean delivery.

METHODS:
We performed a pilot survey study of women after cesarean delivery from August 2016 to July 2017. Inclusion criteria included women 18 years or older, post primary or repeat cesarean delivery with regional anesthesia. Exclusion criteria included general anesthesia, wound infection, patient-controlled analgesia postoperatively, and prolonged hospital stay. Patients received standardized opioid and ibuprofen prescriptions upon discharge (30 tablets of ibuprofen 600mg, and 30 tablets of oxycodone-acetaminophen 5/325mg or hydrocodone-acetaminophen 5/325mg). Participants responded to an online survey two weeks following delivery, which inquired about pain control and amounts of pain medications used. Patient demographics, medical and surgical history was collected.

RESULTS:
A total of 143 women were enrolled and 65 women participated in the online survey. 52 percent of patients had at least 10 extra opioid tablets remaining at the two-week postoperative time point. The amount of opioid tablets used after hospital discharge did not correlate with patient age, body mass index, smoking status, current or past drug abuse, hypertensive diseases, diabetes, number of previous cesarean deliveries, patients’ ability to breastfeed or provide infant care, or number of prescription refills (p>0.05). Increased number of opioid tablets used did not correlate with increased satisfaction with pain control.

CONCLUSION:
Opioid medications are potentially prescribed in excess of the amount needed for outpatient pain control. Patterns of opioid use following cesarean delivery are difficult to stratify based on patient characteristics and risk factors.
Randomized Double-Blinded Comparison of Titrated Oral Versus Vaginal Misoprostol for Labor Induction [24N]
Authors: Kennel Patricia , Fu Jessica , Frisch Donald , Hom Katherine , Allen Hilary , Matsunaga-Kirgan Marsha 
Published: April 2018

INTRODUCTION:
For labor induction of an unfavorable cervix, we propose oral misoprostol, titrated to uterine response, to maximize safety and efficacy, based upon past studies.

METHODS:
Randomized double-blinded study. Identically appearing oral and vaginal study dosages were prepared containing either 25mcg misoprostol or placebo. The pharmacist randomized the study participants to receive either an “oral packet” (oral misoprostol, vaginal placebo) or a “vaginal packet” (opposite). Patients received both an oral protocol (quantity of capsules titrated to uterine contractions, every 2hrs) and vaginal protocol (25mcg/placebo every 4hrs) simultaneously. Providers and patients were blinded.

RESULTS:
Un-blinding revealed 28 oral and 22 vaginal participants, with four oral, and five vaginal participants removed (imperfect consent forms, missing data). Confounding variables had no statistical significance. Primary outcomes: 1) Time to Bishop Score > 7: Titrated oral route was 9.94 hours (Standard Deviation 5.149, 95%CI 6.82-13.05). Vaginal route was 6.59 hours (SD 1.826, 95%CI 5.06-8.11). 2) Time to NSVD: Titrated oral route was 15.52 hours (SD 5.862, 95%CI 11.98-19.06). Vaginal route was 12.74 hours (SD 4.790, 95%CI 8.74-16.74). 3) Change in Bishop score: Titrated oral route was 3.39; Vaginal route was 5.25. Several safety parameters and side effects were evaluated, showing a trend towards the oral route being safer. Approximately 25% of the oral route participants reached the maximum oral dose of 75 mcg, and none needed dosage reduction. Approximately 80% of all participants preferred oral administration because they disliked vaginal placement, while 20% preferred the vaginal administration because it “worked better” and they “dislike pills.”

CONCLUSION:
Results suggest our oral titrated protocol has less efficacy and side effects, although numbers didn’t reach statistical significance. Patients had strong preferences for the oral route. There is potential for future studies based upon our study. With a thorough review of recent studies, we can redesign our study in many ways, including a higher dose of oral misoprostol.
Centering Pregnancy Does Not Affect Rates of Breastfeeding at Postpartum Discharge [25N]
Authors: Hosein Safiyah , Paoletti Andrew , Pitcairn-Ramirez Alexis , Bondy Jessica , Cohen Arnold , Jaspan David 
Published: April 2018

INTRODUCTION:
Centering Pregnancy, a group prenatal care model, has been shown to have many benefits including increased breastfeeding rates in postpartum adolescents. We examined if our Centering Pregnancy program demonstrated increased breastfeeding rates overall.

METHODS:
A retrospective chart review was performed on all patients who delivered at our inner city tertiary care hospital from June 2016 to June 2017. This included 267 Centering patients and 2289 patients who received routine office based prenatal care. Patients who participated in our Centering Pregnancy program did so secondary to schedule availability and patient preferences. Center Pregnancy promoted breastfeeding through educational materials and lactation consultant educational sessions. Data on breastfeeding vs. bottle feeding choice was obtained on all patients via EMR abstraction at the time of postpartum discharge. Statistical analysis was performed using Chi-squared test for independence.

RESULTS:
Of the 267 Centering Pregnancy patients, 147 (55%) were breastfeeding at time of discharge, 120 (45%) were not. Of the routine prenatal care patients, 1278 (56%) were breastfeeding at time of discharge, 1011 (44%) were not. No statistical difference was noted in breastfeeding between the two groups. A subanalysis on patients with government assistance insurance similarly showed no difference in the rate of breastfeeding.

CONCLUSION:
Centering Pregnancy did not increase breastfeeding rates at the time of postpartum discharge. It may be useful to investigate breastfeeding rates at 3 and 6 months postpartum to look at continued adherence.
Does Opioid Maintenance Therapy Decrease the Risk of Neonatal Withdrawal in Mothers with Opioid Use Disorder? [28N]
Authors: Ly Victoria , Persad Malini D. , Herrera Kimberly , Garry David , Garretto Diana 
Published: April 2018

INTRODUCTION:
The objective of the study is to determine if opioid maintenance therapy decreases the risk of neonatal abstinence syndrome in pregnant women with opioid use disorder.

METHODS:
A retrospective cohort study of pregnant women with opioid use disorder was performed at a tertiary care hospital from January 2016 to June 2016. Women were identified using the hospital's delivery logs. Women were categorized by whether they were on opioid maintenance therapy or actively using opioids. Maternal demographics, medical history, social history, delivery characteristics and neonatal outcomes were collected. A composite adverse neonatal outcome score was created and defined as the presence of any of the following: preterm delivery, birthweight <2500 grams, Apgar score < 7 at 5 minutes, NICU admission, and neonatal abstinence syndrome. Parametric and nonparametric statistics were used to compare groups. A p value of < 0.05 was considered statistically significant.

RESULTS:
Of 1,927 women who delivered, 50 women qualified for the study. There were no statistically significant differences in demographic characteristics between groups. Women on opioid maintenance therapy delivered at a statistically significant higher gestational age, had a higher neonatal birth weight and lower NICU admission rate compared to active opioid users. There were no statistically significant differences in neonatal outcomes, including neonatal abstinence syndrome, between groups.

CONCLUSION:
Opioid maintenance therapy use in pregnant women with opioid use disorder does not decrease incidence of NAS, but use may decrease the risk of preterm birth, low birth weight, and NICU admission.
Genetic Counseling Services in Oncology: Recognizing the Underutilization of Referrals in At-Risk Cancer Patients [37N]
Authors: Palvia Vijay , Taylor Nicholas , Andrea Smith , Zighelboim Israel 
Published: April 2018

INTRODUCTION:
Despite equal access to family history and screening guidelines, we hypothesize that there is a failure to identify “automatic referral” patients (i.e. < 50 years old, histology, and family history) for genetic counseling services among oncologic practices.

METHODS:
A retrospective chart review was completed among 3 oncologic practices (gynecologic - GO, surgical - SO and medical - MO) at St. Luke’s University Health Network (SLUHN). Inclusion criteria required an eligible cancer diagnosis. All eligible patients were screened by the National Comprehensive Cancer Network (NCCN) guidelines. Primary outcomes included the rate of “failure to identify” (FTI) patients who met criteria for referral including “automatic referral.” Secondary outcomes included rate of genetic referrals. Data collection underwent descriptive testing and comparisons were analyzed with chi-square calculations.

RESULTS:
Each oncologic practice contributed eligible patients (47 GO, 44 SO, 40 MO) to the study. The rate of “failure to identify” patients among those that met criteria for were as follows: GO - 14% (4/28), SO - 31% (5/16), and MO - 33% (3/9) (p = 0.30). Proportions of “automatic referral” patients that were unidentified were as follows: GO - 22% (4/18), SO - 40% (4/10), and MO - 17% (1/6). Referral rates by sub-specialty were as follows: GO 100%, SO 91%, and MO 66%.

CONCLUSION:
An unexpected ratio of unidentified patients that met criteria for “automatic referral” was seen. These findings should constitute the basis for a unique opportunity and comprehensive strategy aimed at identifying and better serving at-risk cancer patients within our network.
Effects of Male Partner Age on Pregnancy and Obstetric Outcomes in Frozen Oocyte Donor Cycles [40N]
Authors: Capelouto Sarah M. , Nagy Zsolt P. , Spencer Jessica B. , Shapiro Daniel , Hipp Heather S. 
Published: April 2018

INTRODUCTION:
Nationally, paternal ages at conception are rising, as are concerns over potential risks in pregnancy and child health. It is unclear if advancing male age influences in vitro fertilization (IVF) success or obstetric outcomes. Frozen donor oocyte IVF offers an ideal model to study this, since oocytes come from young healthy women and intracytoplasmic sperm injection (ICSI) is performed. Thus, our objective was to examine whether paternal age affects outcomes in frozen donor oocyte IVF.

METHODS:
Data were analyzed from 852 patients undergoing embryo transfer derived from a vitrified oocyte donor bank between 2008-2015. Each recipient received a cohort of oocytes that were thawed, fertilized via ICSI, and transferred on post-fertilization day 5. Multivariate logistic regression was used to estimate rates of live birth (LBR), low birth weight (LBW), and preterm delivery (PTD) after the recipient’s first embryo transfer from the cohort.

RESULTS:
Mean age among male partners was 41.47+/-6.19 years. The LBR with male partner ages of <35, 36-40, 41-45, 46-50, and >50 years were 57.1%, 55.9%, 57.1%, 52,1%, and 56.3% respectively. After adjusting for covariates, male age was not associated with implantation, clinical pregnancy, or LBR. The rates of PTD ranged from 6.2-13.5% for male age <50. For men >50, PTD was elevated (33.3%), but this was not statistically significant after adjustment (aRR 2.49, 95% CI 0.84-7.39). The difference in LBW with men >35 was not statistically significant.

CONCLUSION:
Advancing male age is not associated with rates of live birth, low birth weight, or preterm delivery in frozen donor oocyte cycles.
A Vasectomy Training Curriculum for Ob/Gyn Residents [6O]
Authors: Gorrindo Phillip , Guo Xiaoyue , Fay Kathryn , Chang Katherine , Hall Evelyn , Hammond Cassing 
Published: April 2018

INTRODUCTION:
Vasectomy is a safe and effective form of contraception. However, sterilization rates are up to three times higher in women than in men. One barrier to increased use of vasectomy is the availability of trained providers. Unfortunately, vasectomy has traditionally been excluded from the skill set of Ob/Gyns.

METHODS:
We surveyed our Ob/Gyn residents to gauge interest in a vasectomy curriculum (VC). We identified stakeholders involved in developing a VC, including Ob/Gyn residency leadership, Urology and Family Planning faculty, Graduate Medical Education leadership, and representatives from our institution's legal department. In a multidisciplinary team, we developed a VC that leveraged the expertise of Urology faculty and will soon be offered to Ob/Gyn housestaff at our institution.

RESULTS:
Thirty-eight of 48 (84%) residents responded to the survey and 58% agreed that they would like to provide vasectomies. Our multidisciplinary team discussed issues related to developing a VC, including: medicolegal, credentialing, and privileging questions, potential competition between Urology and Ob/Gyn, and ethical implications of Ob/Gyns providing vasectomies. We then developed a VC built on Urology housestaff training. We will soon offer this VC to Ob/Gyn residents, with an option to perform vasectomies in Urology clinic.

CONCLUSION:
There is substantial interest among our Ob/Gyn residents to gain vasectomy experience. Barriers to training Ob/Gyns to perform vasectomies are not insurmountable. We suggest that there is an compelling ethical argument for Ob/Gyns to be able to provide vasectomies. Finally, our VC may serve as the foundation for other institutions to begin building their own VC for Ob/Gyn housestaff.
Uncovering Female Reproductive Pathology: Horizontally Integrated Observational Cadaveric Study [10O]
Authors: Litvinova Katerina , Pruzansky Alix 
Published: April 2018

INTRODUCTION:
Systems-based curricula have dominated medical school education over the recent decade, but anatomy has largely remained separate from this integration. Cadaveric dissection incorporates anatomy, histology, microbiology, pathology, and clinical significance into the early training of physicians. For pre-clinical students with particular interest in obstetrics and gynecology, a plethora of reproductive pathology can be uncovered upon close cadaveric analysis and more advanced dissection methods. Students can derive great benefit by re-visiting the anatomy lab to gain richer understanding of reproductive disease pathophysiology.

METHODS:
Ten female cadavers aged 60 to 98 (M=78 SD=12.8) from Ross University School of Medicine anatomy lab were examined for cervical, uterine, and ovarian pathology. Students reviewed pelvic anatomy and learned surgical techniques used to perform hysterectomies and cervical cone biopsies under guidance of a reproductive surgeon. Students processed harvested tissue, performed H&E staining along with HPV assays, and interpreted slides with pathologists. Through literature review and active discussion, faculty helped students relate clinical relevance of observational cadaveric study to general trends in obstetrics and gynecology.

RESULTS:
All ten female cadavers revealed reproductive pathology, spanning cervical (cervical intraepithelial neoplasia stage I, atypical cervical glandular hyperplasia, Nabothian cysts), uterine (endometrial polyp, adenomyosis, leiomyomas), and ovarian (epithelial inclusion cysts, hyalinized atrophic ovarian follicles, ovarian calcifications) findings.

CONCLUSION:
Observational cadaveric study encourages active learning, facilitates basic and clinical science integration, and allows for evaluation of reproductive pathology trends among the older female population. This not only profoundly engages aspiring obstetrician-gynecologists, but also fortifies an institution’s research profile while optimally utilizing gross anatomy lab resources.
Safe Surgery Education: Improving Patient Care on Labor and Delivery Units [17O]
Authors: Chen Joseph , Erickson Laurie 
Published: April 2018

INTRODUCTION:
In 1999, the U.S. Institute of Medicine launched a movement in healthcare to improve patient care and to decrease medical errors on a national level. These initiatives sparked dramatic changes to improve provider hand-off processes, decrease preventable errors and adverse outcomes. Similarly, observational obstetrical studies have shown that maternal morbidity and mortality can be decreased through checklists and safety steps. At our institution, we introduced Obstetrical Safe Surgery Education Program to further decrease medical errors in vaginal (VD) and cesarean deliveries (CD). This prospective study evaluated objective differences in patient care using standardized audit tools before and after program introduction at a single institution.

METHODS:
Baseline delivery audits of OBGYN physicians, nursing and anesthesia providers were performed using an institutionally-standardized checklist (VD-20 items, CD-62 items) by trained observers from January 2015-May 2016. Education of staff and physicians was provided using visual aids, formal training courses, lectures and mock drills. Following this,128 VD and CD were randomly audited. Objective measures included accuracy of instrument counts, effective communication between staff and adequate documentation of care. Scores were calculated based on total percentage of correctly performed items.

RESULTS:
Prior to the education introduction, the average percentage of correctly performed items in VD and CD were 69% and 88%, respectively. Following the educational period, the average percentages respectively increased to 81% (P=0.29), 91% (P=0.94). Improvements were observed in all objective measures.

CONCLUSION:
A multimodal approach of healthcare education can lead to clinical improvements in patient care. Larger studies are required to delineate barriers of education implementation.