bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Sleep Habit on the Contraceptive Effectiveness of a Fertility Awareness-Based App [1O]
Authors: Rowland Simon , Kallner Helena Kopp , Gemzell-Danielsson Kristina , Trussell James , Scherwitzl Elina Berglund , Scherwitzl Raoul 
Published: May 2019

INTRODUCTION:
The Natural Cycles digital fertility awareness-based method of contraception computes a daily fertility status based on dates of menstruation and basal body temperature (BBT) measurements. Every morning, the user measures her BBT upon waking, before getting out of bed. This study aims to further understand the impact of sleeping habits on the effectiveness of the app for pregnancy prevention.

METHODS:
A questionnaire addressing sleeping habits was sent out to users through an in-app message. The response rate was 45.2%, resulting in 39,244 women being included in the analysis. The sample was divided into cohorts based on the selected questionnaire answer. For each cohort, the contraceptive effectiveness was calculated as a one year typical-use Pearl Index (PI). (EPN, Stockholm, diary number 2017/563-31).

RESULTS:
Most users reported that they wake up at the same time during work days (52%). Other answers were; wake up several times during the night (16%), wake same time every day (14%), shift work (12%), and sleep in or snooze (6%). The PI of all respondents was 4.9 (SD±0.1), sensitivity analysis showed that if those who did not respond were included, the PI was significantly higher (PI 6.6±0.1). Sub-cohort analysis showed that those reporting “sleep late/snooze” had the lowest PI (3.7±0.4).

CONCLUSION:
In this study, the fertility awareness-based method app had a typical-use PI between 3.7 and 6.1, depending on self-reported sleeping habits. Respondents had a lower PI than those who did not respond, suggesting that other factors such as behavior and compliance influence the effectiveness outcome.
Impact of Cesarean Delivery Rate Calculation Method on Hospital Ranking [6O]
Authors: Langen Elizabeth Suzanne , Low Lisa Kane , Dasmunshi Sudipta , Kamdar Neil , Moniz Michelle , Morgan Dan 
Published: May 2019

INTRODUCTION:
How to best quantify a hospital's cesarean delivery (CD) rate remains controversial. We compared hospitals' ranked performance using two common methods of calculating the CD rate.

METHODS:
We included 64 hospitals in the Blue Cross Blue Shield (BCBS) Michigan Value Collaborative. We calculated the nulliparous, term, singleton, vertex (NTSV) CD rate based on birth certificate data and the low risk CD rate defined by the Society of Maternal Fetal Medicine using BCBS claims data. Hospitals were ranked according to each CD rate, changes in quartile rank were identified, and hospitals that did and did not shift quartile rank were compared. We compared changes in NTSV and SMFM CD rates for each hospital in the five-year period using Generalized Linear Models of their slope.

RESULTS:
The median NTSV CD rate was 27.9% (range: 17.7% to 39.5%); the median SMFM CD rate was 15.6% % (range: 9.5% to 26.5%). 30 (48%) hospitals shifted quartile rank when using NTSV vs SMFM methodology. Hospitals were more likely to shift quartile rank if their CD rate ranking placed them in a middle quartile or if they had a smaller share of BCBS patients. When comparing the change in hospital specific CD rates over the five year study period, there was concordance between the NTSV and SMFM methodology for only 69.2% (31 hospitals).

CONCLUSION:
As hospitals' primary CD rate comes under increasing scrutiny, payers, patients and quality improvement efforts should recognize the variability in rank that can be driven by measurement approach.
Spinal Muscular Atrophy: Ordering Trends Pre- and Post-ACOG Committee Opinion 691 [17O]
Authors: Dyr Brittany , Fanelli Kimberly , Weinblatt Vivian , Heim Ruth , Donnenfeld Alan E. 
Published: May 2019

INTRODUCTION:
Spinal muscular atrophy (SMA) is a leading inherited cause of infant death and is second to cystic fibrosis (CF) as a common, life-limiting autosomal recessive disorder. In March 2017, the American College of Obstetrics and Gynecology (ACOG) released a committee opinion (691) stating that screening for SMA should be offered to all patients considering pregnancy or currently pregnant.

METHODS:
To assess the uptake of SMA screening following the ACOG recommendations, a retrospective analysis of tests ordered from healthcare practices for single gene carrier screening of SMA and CF was performed. Data were analyzed over two equal time periods pre- and post-March 2017.

RESULTS:
Data were collected from nearly 4,000 healthcare providers who ordered at least one SMA test in the study period. The average number of monthly tests ordered per practice was six pre-ACOG opinion, and 16.7 post-ACOG opinion. Over 50% of practices did not order SMA testing prior to the ACOG opinion. Among practices regularly ordering testing for CF there was an increase in testing for SMA post-opinion, however, the number of CF tests received was 27% higher than SMA tests received.

CONCLUSION:
Carrier screening for SMA increased more than two and half times post ACOG opinion, likely due to the new recommendations. Despite the increase in SMA carrier tests, the number of SMA tests post-opinion did not match the number of CF tests from healthcare practices sending both tests to our laboratory. These findings suggest increased adoption of SMA screening guidelines but still not at the level observed for CF.
Women's Perspectives on Preferences for Care During Labor and Delivery [23O]
Authors: Plough Avery , Rucker Amber , Short Trisha , Filosa Shannon , Loveless Donald E. , Shah Neel T. 
Published: May 2019

INTRODUCTION:
Research across healthcare has shown variation in patient's preferences for the information and decision-making authority they would like to have during their care. Patients' voices can be particularly important in obstetrics where women's preferences combined with clinician's expert judgment are critical to making the best possible decisions in complex and uncertain situations.

METHODS:
All women >15 years old who delivered at a large hospital in Tulsa, Oklahoma and did not have a scheduled cesarean or fetal demise were invited to complete a survey about their labor and delivery care experience prior to the implementation of a team-based quality improvement project. Participating women completed the multiple choice survey on paper during their postpartum stay. The Harvard and hospital IRBs approved the study.

RESULTS:
186 women completed the baseline postpartum survey from July-September, 2018. Among these women, 97% of women at least wanted to be informed about their care, and 80% also wanted to be engaged in shared-decision making about their care. 86% of women had the role they wanted in their care. 90% felt comfortable sharing their preferences with their full care team, but only 78% felt that these preferences made a difference in their care.

CONCLUSION:
The vast majority of women want to both be informed about their care in labor and delivery and play an active role in shared decision-making. The gap between women reporting having the role they wanted in care and feeling that their preferences made a difference in their care highlights opportunities for improvement in labor and delivery care.
Patient Preference of Gynecologist Attire in the Office Setting [13P]
Authors: Echeverri Natalia , Salazar Alejandra , Timmons Douglas , Willis Markie , Palin Hannah , Carugno Jose 
Published: May 2019

INTRODUCTION:
Patient's perception of their physician can affect physician-patient relationship. Does gynecologist attire in the office setting influence patient's perception of physician quality, level of trust, return for follow up visits or likelihood to recommend the physician to a friend or family member?

METHODS:
A cross sectional anonymous survey was given to 200 patients who were seen in the office gynecology setting in a mayor academic urban center. Subjects were shown a series of 4 pictures of a hypothetical physician in 4 different set of clinical attire, business (suit), professional (white coat), surgical (surgical scrubs) and casual (jeans and t-shirt) and were asked which physician they prefer for different hypothetical scenarios (office visit, major surgery, gynecologic emergency). Descriptive statistic was used to analyze the data.

RESULTS:
Mean age 32.9 year, most patient were Caucasian (59%) and self-identified as Hispanic (58.8%) Most patients preferred physicians wearing white coats (62%) followed by surgical scrubs (20%) (p<0.034). Although when presented the hypothetical scenario of counseling for mayor surgery patients preferred physician wearing scrubs. (p<0.007) In case of a gynecologic emergency surgical scrubs and white coat were equally preferred. (p<0.01) Attire did not have significant effect on patient's perception of gynecologist knowledge, ability to care as well as level of authority.

CONCLUSION:
Patients prefer gynecologist wearing white coats or surgical scrubs when in the office setting. The use of suit as well as casual attire is not well perceived by patients and should be avoided if possible.
Surgical Equipment and Medication Price Awareness Amongst Obstetrician Gynecologists [16P]
Authors: Nguyen Michelle , Gray Kendra , Steck-Bayat Kayvahn , Mahnert Nichole 
Published: May 2019

INTRODUCTION:
Milestones established in 2013 by the Accreditation Council for Graduate Medical Education (ACGME) supports the addition of a systems-based practice milestone to assess residents' incorporation of cost awareness into clinical judgment and decision making. Minimal formal education is provided to residents regarding costs related to medications and devices. The primary aim of this study was to evaluate teaching faculty and obstetrical learners accuracy at estimating the costs of common obstetrical devices and medications.

METHODS:
After an IRB was approved, an anonymous survey was distributed to OB/GYN residents and attendings with teaching privileges at University affiliated Banner Health hospitals in Arizona. Participants were asked to provide demographic data and rate statements related to cost awareness pertaining to patient care in addition to estimates of cost of commonly used of surgical equipment and medications based on images. Statistical analyses was then performed on the data.

RESULTS:
The subjective survey showed that the majority of respondents felt that cost was important in the selection of surgical devices/items, that surgical device pricing should be transparent, and that their personal knowledge on prices of surgical devices/medications at the institution was below average or poor. The statistical analysis was consistent with this assessment as the majority of respondents were not able to accurately estimate the pricing of items within a 10% range.

CONCLUSION:
At academic institutions, where cost awareness is expected to be a part of residency training, better methods to educate teaching attendings and residents should be considered to make ACGME milestone assessments more accurate and meaningful.
The Readability of Online Patient Education Materials from Major Obstetrics and Gynecology Societies [17P]
Authors: Fahimuddin Fatimah Z. , Sidhu Sanam , Agrawal Anubhav 
Published: May 2019

INTRODUCTION:
Poor health literacy, or the diminished ability to obtain, process, and understand medical information to make an appropriate health-related decision, may be a factor in rising medical expenses. With more emergency department visits and worse health outcomes, the estimated cost of avoidable medical expenses ranges from $106 to $238 billion annually. In an attempt to correct this, the American Medical Association, National Institute of Health, and United States Department of Health and Human Services recommend all patient education materials be written at or below a sixth-grade reading level. Access to appropriate online educational information may be a limiting factor in overcoming poor health literacy and its associated outcomes.

METHODS:
An analysis of the 410 online patient education materials from eight recognized obstetrics and gynecology societies was completed, and Flesch-Kincaid Grade Level (FKGL), Flesch Reading Ease (FRE), Gunning Fog Scale (GFS), and SMOG Grade (SMOG) readability scores were calculated to assess the readability of these resources.

RESULTS:
Across all eight obstetrics and gynecology societies, the readability scores exceeded the recommended sixth grade reading level. The average FKGL, FRE, GFS, SMOG for the 69 obstetrics-related articles were 8.9, 55.8, 12.1, 11.5, respectively. The mean FKGL, FRE, GFS, SMOG for the 341 gynecology articles were 8.7, 53.5, 11.9, 10.6, respectively.

CONCLUSION:
Online patient education materials provided by major obstetrics and gynecology societies do not currently adhere to recommended readability guidelines. Continued efforts to provide accessible and informative patient education materials is needed to help improve health literacy for women.
Successful Management of Severe Idiopathic Fetal Hydrops With Thoracoamniotic Shunts [34P]
Authors: Rondon Leah , Martinuzzi Kurt , Woodham Padmashree , Hannah Dawn , Krishna Iris 
Published: May 2019

INTRODUCTION:
This case report describes successful management of severe idiopathic fetal hydrops with thoracoamniotic shunts.

METHODS:
Patient is a 38 y/o G2P0010 who initiated care at 6 weeks. She was evaluated by perinatology for AMA and a fibroid uterus. First trimester and anatomy ultrasounds were unremarkable. She had low-risk genetic screening and normal MSAFP. A growth ultrasound at 23 weeks demonstrated bilateral pleural effusions. Evaluation included: normal fetal echocardiogram, Rh positive with no antibodies, negative serum TORCH titers, normal microarray, and negative amniotic fluid TORCH PCR. Due to worsening bilateral pleural effusions and development of fetal hydrops, patient underwent left-sided thoracoamniotic shunt placement at 25 and 26 weeks after receiving antenatal corticosteroids with resolution of left-sided pleural effusion and hydrops. She was admitted at 31 weeks for re-accumulation of left-sided pleural effusion and administration of rescue corticosteroids. At 32 weeks the fetus was again noted to have fetal hydrops and delivery was recommended. A primary LTCS was performed due to nonreassuring fetal heart tones. Patient delivered a female fetus weighing 1845 gram with APGARS of 2/7. The neonate spent 25 days in NICU with no evidence of pulmonary hypoplasia and was discharged home in stable condition. There was no identified etiology for hydrops and neonate was thriving at 6 week postpartum visit.

CONCLUSION:
Fetal intervention in a severe case of fetal hydrops can lead to an excellent neonatal outcome. Placement of thoracoamniotic shunts allowed for fetal lung development in setting of severe pleural effusions and allowed an additional 6 weeks of intrauterine growth.
Secondary Traumatic Stress in Obstetrics & Gynecology: Provider Experience and Programmatic Needs [3Q]
Authors: Kruper Abbey , Kaljo Kristina , Parthum Kristina , Treat Robert , Domeyer-Klenske Amy Elizabeth 
Published: May 2019

INTRODUCTION:
Secondary traumatic stress (STS) is the resulting effects from exposure to adverse medical events and may include symptoms of depression, fear, or work avoidance. Â1 This study aims to understand STS in Ob-Gyn physicians and assess needs for interventions to promote wellness.

METHODS:
An explanatory mixed-methods analysis used an anonymous survey distributed to an Ob-Gyn department at a Midwest academic institution followed by focus groups and individual interviews. IBM® SPSS® 24.0 generated descriptive statistics, point-biserial correlations, and reliability analysis. Constant comparative analysis identified themes. Institutional IRB approval was obtained.

RESULTS:
Twenty-seven individuals (52% residents/40% faculty) completed the reliable (alpha=0.71) survey. Ten faculty participated in interviews/focus groups. Anxiety (81%), guilt (62%), disruptive sleep (58%) were most frequently reported STS symptoms (mean number of symptoms=(3.4±2.1)). Individuals reporting anxiety were more likely to seek support from colleagues (rpb=0.5, p<.006); those reporting guilt would go to friends (rpb=0.5, p<.007). Disrupted sleep more commonly led to seeking mental health services (rpb=0.5, p<.007). Provider description of STS included: responsibility, guilt/shame, self-doubt, anxiety/rumination and sleep disturbance. Effects varied from task avoidance to hypervigilance. Protective factors included support from colleagues and ability to compartmentalize work/home. Mental health treatment and faith-based, introspective beliefs facilitated coping. Desires for support varied: those reporting anxiety were more interested in peer-to-peer responders (rpb=0.6, p<.001), those reporting guilt would use debriefing sessions (rpb=0.4, p<.023).

CONCLUSION:
STS wellness programs including peer support and group processing can promote collegiality, shared learning, and emotional support. A breadth of resources is imperative to address individual provider needs.
The Impact of ICD-10 on Obstetric Coding [5Q]
Authors: Gomez Daniela , Jayakumaran Jenani , Schuster Meike 
Published: May 2019

INTRODUCTION:
We aimed to review the accuracy of current International Classification of Diseases and Related Health Problems (ICD) coding practices at our institution which affect the delivery complication rate.

METHODS:
A retrospective review of vaginal and cesarean delivery complications with respective ICD-10 codes was performed (September 2017 to June 2018) at Robert Wood Johnson Barnabas Health. After review of 3 months of data, codes used erroneously were identified. Re-education of both coders and providers was performed. Subsequent coding rates were tracked for the remainder of the study period.

RESULTS:
Based on the Joint Commissions list of reportable complications, 67 cesarean and 177 vaginal delivery complications were identified over a 10-month period. Ten cesarean and 26 vaginal delivery complications were found to be coded erroneously; recoding decreased complications by 14% for both. Between September and January, recoding rates for cesarean and vaginal delivery complications were 26% and 15% respectively. After re-education in January, rates dropped to 3% (cesarean) and 14% (vaginal). Interim review in April identified codes persistently being used inappropriately with respect to vaginal delivery complications, despite re-education. Restrictions requiring supervisory review and physician query were placed on codes in question, further decreasing vaginal delivery complications. We decreased our complication recoding percentage from 26% to 3% and 15% to 11% for cesarean and vaginal deliveries respectively.

CONCLUSION:
Our findings suggest detailed chart review by medical providers in addition to re-education of coding staff and providers can improve accuracy rates for obstetrics coding.
Uterine Arterio-Venous Malformations: An Unrecognized Cause of Abnormal Uterine Bleeding [13Q]
Authors: Allen Ashley , DeLeon Frank D. , Kremer Timothy , Flood-Shaffer Kellie F. 
Published: May 2019

INTRODUCTION:
Uterine arteriovenous malformations (AVM) have been considered a rare, but life-threatening cause of uterine bleeding. Not including this condition in the differential diagnosis of abnormal uterine bleeding can lead to misdiagnosis with erroneous treatment, or can delay diagnosis with potential complications associated with severe blood loss.

METHODS:
A 20-year-old woman with a recent history of a spontaneous abortion presented to the emergency room for a syncopal episode and very heavy vaginal bleeding (hgb 4.9). After transfusion, patient was treated with oral contraceptives. Two months later, she presented again with a near syncopal episode and further heavy uterine bleeding. Further evaluation with doppler imaging revealed an area of increased vascularity in the myometrium. Angiography revealed a hypertrophic arterial mass with early venous drainage. A unilateral uterine artery embolization was performed which was successful in stopping further abnormal heavy uterine bleeding.

CONCLUSION:
Uterine AVMs should be considered in reproductive age women with a recent history of pregnancy presenting with continuous vaginal bleeding. Bleeding may present on a spectrum from mild to severe depending on size of the defect. Doppler imaging is a useful screening tool. Angiography confirms the diagnosis, provides a method of definitive treatment, and should be considered in patients when Doppler imaging cannot exclude the presence of an AVM.
Over 50% of Nulliparous Women ≥40 Years of Age Will Have a Cesarean Delivery [31Q]
Authors: Fay Emily E. , Sienas Laura , Napolitano Peter , Sitcov Kristin , Souter Vivienne L. 
Published: May 2019

INTRODUCTION:
Women ≥40 years old at delivery are increasing and older women are at higher risk for adverse pregnancy outcomes. We sought to evaluate delivery outcomes in these women.

METHODS:
We conducted an IRB exempt, retrospective cohort study using data from a multi-center quality initiative. Nulliparous singleton births between 1/2012-12/2017 at participating hospitals were included. Patients with intrapartum transfers, missing birth data, or missing/implausible data for maternal age were excluded. Age was stratified into 4 groups: 12-19 years, 20-29 years, 30-39 years, and 40-55 years. Rates of delivery outcomes were compared between women aged 20-29 years and 40-55 years using a Ï‡2 test. Adjusted relative risks were calculated after controlling for obesity (body mass index ≥30), race-ethnicity, and chronic hypertension.

RESULTS:
There were 48,093 nulliparous singleton births at 20+0 to 42+6 weeks' gestation. After exclusions (n=1891) were removed, the cohort included 46,202 births: 36,146 (78.2%) in 20-29 years and 1155 (2.5%) in 40-55 years groups. Only 33% of older women achieved a spontaneous vaginal birth, compared to 62% of women age 20-29 (p<0.001). This difference is primarily due to high cesarean delivery (CD) rate (57.7%) in older women, with 25.8% of older women never attempting vaginal birth. Older women are at significantly higher risk of having a CD for all major indications with only a minority (2.8%) of older women having a non-medically indicated CD.

CONCLUSION:
Older women have an over 50% risk of CD with lower rate of attempting and achieving vaginal birth. This can be useful in counseling about delivery expectations.