bluuebunny/crossref_metadata_2025_split huggingface dataset:
Modern Microscopy On the Light Side
Authors: Paienik Skip 
Published: March 2018

Abstract
Developments in microscopy in the last twenty years or so have been dramatic and impressive. Not only can individual atoms be seen with relatively inexpensive instruments, but is even possible to manipulate them, fulfilling the prophecies made by Richard Feyrman in his “Room at the Bottom” address given in 1959. Why, one might reasonably ask. when it is possible to observe, manipulate, and identify single atoms, would someone want to waste their time with an instrument so “old fashioned” as a light microscope?
Balints Gedanken in einer zeitgemäßen Form
Authors: Davidsen Annette 
Published: March 2018

ZusammenfassungIn der Primärversorgung ist das Zusammenspiel zwischen Körper und Seele besonders wichtig. Im Gegensatz zu der Sekundärversorgung, wo Fachärzte sich um eine spezielle Symptomatik des Patienten kümmern, ist die Primärversorgung des Hausarztes dafür zuständig, sich zu dem komplexen Zusammenhang von körperlichen und seelischen Symptomen des Patienten zu verhalten, und ihn in einer gesamtheitlichen Perspektive zu verstehen. Balint interessierte sich für die Arzt-Patienten-Beziehung in der Primärversorgung und für die Behandlung der ganzen Person. Gemeinsam mit Enid Balint trainierte er Allgemeinärzte in einem ganzheitlichen Verständnisprozess, wo Körper und Seele in einer dynamischen Wechselwirkung stehen. Balints Gedanken waren jedoch nicht sehr deutlich beschrieben und haben in der Primärversorgung nicht Fuß fassen können. Heute wird die Primärversorgung in ihrer bestehenden Form für bedroht gehalten. Um dem entgegenzuwirken, benötigt sie einen theoretischen Zugang, der Körper und Seele als eine Einheit betrachtet. In diesem Artikel beschreibe ich verschiedene Begriffe, die für eine solche Theorie die Grundlage bilden könnten. Ich zeige, dass Balints Auslegung des Verständnisprozesses in der Arzt-Patient-Beziehung mit der Definition des intersubjektiven Verstehens der Mentalisierungstheorie übereinstimmt und darüber hinaus auch mit der phänomenologischen Einstellung, die eben die Unterscheidung von Körper und Seele ablehnt. Allgemeinärzte wie z. B. McWhinney und Rudebeck haben ein solches ganzheitliches Denken formuliert. In England überlebte die Primärversorgung in den fünfziger Jahren nur dank Balints Überzeugungen. Wenn die Primärversorgung heutzutage wieder bedroht ist, könnte dies mit dem erneuten Verschwinden des psychodynamischen Zuganges in Zusammenhang stehen. Die Mentalisierungstheorie ist grundlegend psychodynamisch. Sie stimmt mit den Haltungen Balints und der Allgemeinärzte, die sowohl von Balint als auch von der Phänomenologie inspiriert waren, überein. Allgemeinärzte können das Mentalisieren trainieren. Dabei würden sie den psychodynamischen Zugang und die Fähigkeit, sich in die gesamte Situation des Patienten hineinversetzen zu können, bewahren.
Clitoral Reconstruction Using a Vaginal Graft After Female Genital Mutilation
Authors: Mañero Ivan , Labanca Trinidad 
Published: March 2018

BACKGROUND:
Clitoral reconstruction after genital mutilation is a feasible and effective strategy to reduce clitoral pain, improve sexual pleasure, and restore vulvar appearance.

TECHNIQUE:
We describe a novel surgical technique for clitorolabial reconstruction using a vaginal graft.

EXPERIENCE:
We present a series of 32 consecutive women who underwent this procedure at Iván Mañero Clinic, Barcelona, Spain, and were prospectively followed. The total Female Sexual Function Index changed favorably from 16 before surgery to 29 after surgery (P<.05). Likewise, the Female Self-Image Genital Scale changed favorably from 11 to 23 (P<.05).

CONCLUSION:
Clitoral reconstruction after genital mutilation was associated with improved sexual function and genital aesthetic perception.
Statewide Quality Improvement Initiative to Reduce Early Elective Deliveries and Improve Birth Registry Accuracy
Authors: Kaplan Heather C. , King Eileen , White Beth E. , Ford Susan E. , Fuller Sandra , Krew Michael A. , Marcotte Michael P. , Iams Jay D. , Bailit Jennifer L. , Bouchard Jo M. , Friar Kelly , Lannon Carole M. 
Published: March 2018

OBJECTIVE:
To evaluate the success of a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data accuracy rapidly and at scale in Ohio.

METHODS:
Between February 2013 and March 2014, participating hospitals were involved in a quality improvement initiative to reduce early elective deliveries at less than 39 weeks of gestation and improve birth registry data. This initiative was designed as a learning collaborative model (group webinars and a single face-to-face meeting) and included individual quality improvement coaching. It was implemented using a stepped wedge design with hospitals divided into three balanced groups (waves) participating in the initiative sequentially. Birth registry data were used to assess hospital rates of nonmedically indicated inductions at less than 39 weeks of gestation. Comparisons were made between groups participating and those not participating in the initiative at two time points. To measure birth registry accuracy, hospitals conducted monthly audits comparing birth registry data with the medical record. Associations were assessed using generalized linear repeated measures models accounting for time effects.

RESULTS:
Seventy of 72 (97%) eligible hospitals participated. Based on birth registry data, nonmedically indicated inductions at less than 39 weeks of gestation declined in all groups with implementation (wave 1: 6.2–3.2%, P<.001; wave 2: 4.2–2.5%, P=.04; wave 3: 6.8–3.7%, P=.002). When waves 1 and 2 were participating in the initiative, they saw significant decreases in rates of early elective deliveries as compared with wave 3 (control; P=.018). All waves had significant improvement in birth registry accuracy (wave 1: 80–90%, P=.017; wave 2: 80–100%, P=.002; wave 3: 75–100%, P<.001).

CONCLUSIONS:
A quality improvement initiative enabled statewide spread of change strategies to decrease early elective deliveries and improve birth registry accuracy over 14 months and could be used for rapid dissemination of other evidence-based obstetric care practices across states or hospital systems.
Anaphylactic Shock After Intravenous Fluorescein Administration for Intraoperative Cystoscopy
Authors: Lee Toy , Sanderson Derrick , Doyle Paula , Buchsbaum Gunhilde 
Published: March 2018

BACKGROUND:
Rates of administration of intravenous sodium fluorescein during cystoscopy have increased since indigotindisulfonate sodium was removed from the market in 2014. Although sodium fluorescein has been extensively evaluated and found to be safe, side effects including anaphylaxis have been observed, with an incidence between 0.05% and 1.0%.

CASE:
We present a case of anaphylactic shock after administration of intravenous sodium fluorescein for the assessment of ureteral efflux in a patient with a history of frequent severe allergic reactions undergoing urethral lysis and cystoscopy for urinary retention. Cardiopulmonary structure and function were evaluated and found to be normal. An elevated serum tryptase level was identified, indicating an anaphylactoid reaction. Timely recognition of symptoms associated with a severe allergic reaction in the setting of hemodynamic instability with prompt supportive and pharmacologic therapy was vital in the patient's recovery.

CONCLUSION:
Health care providers must be aware of this potential complication, especially in patients with a history of severe allergic reactions.
Family Planning and Counseling Desires of Women Who Have Experienced Miscarriage
Authors: Flink-Bochacki Rachel , Hamm Megan E. , Borrero Sonya , Chen Beatrice A. , Achilles Sharon L. , Chang Judy C. 
Published: March 2018

OBJECTIVE:
To explore initial pregnancy intentions and postmiscarriage family planning needs and counseling preferences of women experiencing spontaneous abortion.

METHODS:
We conducted semistructured qualitative interviews with women who recently experienced spontaneous abortion to explore their feelings about conception, pregnancy, and miscarriage; their future family planning goals; and contraceptive counseling preferences. Two trained coders utilized an inductive, iterative approach to code transcripts and identify themes using Atlas.ti software to organize the analysis.

RESULTS:
We interviewed 26 women reporting varied intentions in their recent pregnancies: 54% were trying to conceive, 27% were not trying but not preventing, and 19% were attempting to avoid pregnancy. Participants reported a range of feelings about the pregnancy diagnoses and eventual miscarriages with some relatively unemotional (“a little disappointed…suffering for two months for nothing”) and others feeling devastated by their pregnancy losses (“in shock,” “for it to be taken away was crushing”). Varying character and intensity of emotional reactions were seen across the range of initial pregnancy intentions. Some participants had consistent childbearing plans before and after miscarriage, whereas others experienced their pregnancies and losses as clarifying events leading to changed goals moving forward (“it was a wake-up call”). Although family planning needs were inconsistently addressed after spontaneous abortion, women were generally receptive to the idea of contraceptive counseling, though they had different preferences regarding timing, ranging from immediately to weeks later.

CONCLUSION:
Women's reproductive goals after spontaneous abortion cannot be inferred based on initial pregnancy intention or emotional reactions to pregnancy loss. Health care providers should offer family planning counseling to all women after spontaneous abortion, remaining responsive to individual patient needs.
Occult Gynecologic Cancer in Women Undergoing Hysterectomy or Myomectomy for Benign Indications
Authors: Desai Vrunda B. , Wright Jason D. , Schwartz Peter E. , Jorgensen Elisa M. , Fan Linda , Litkouhi Babak , Lin Haiqun , Gross Cary P. , Xu Xiao 
Published: March 2018

OBJECTIVE:
To estimate the prevalence of corpus uteri, cervix uteri, and ovarian malignancy in women undergoing hysterectomy or myomectomy for presumed benign indications.

METHODS:
We conducted a secondary analysis of data from the 2014–2015 American College of Surgeons National Surgical Quality Improvement Program. Adult women undergoing hysterectomies and myomectomies without evidence for known or suspected cancer at the beginning of surgery were identified from the database. Our primary outcome measure was pathology-confirmed malignancy in the corpus uteri, cervix uteri, and ovary. We performed adjusted logistic regression analysis to examine the association of patient characteristics with the risk for malignancy.

RESULTS:
Our sample included 24,076 women undergoing hysterectomy and 2,368 women undergoing myomectomy. Malignancy of the corpus uteri was found in 1.44% (95% CI 1.29–1.59%) of the women undergoing hysterectomy. The prevalence varied considerably across surgical routes with the rate being 0.23% (95% CI 0.06–0.58%) in laparoscopic supracervical hysterectomy and 1.89% (95% CI 1.65–2.14%) in total laparoscopic or laparoscopic-assisted vaginal hysterectomy. Older women were significantly more likely to have preoperatively undetected malignancy of the corpus uteri (adjusted odds ratio 6.46, 95% CI 4.96–8.41 for age 55 years or older vs age 40–54 years). Additionally, 0.60% (95% CI 0.50–0.70%) and 0.19% (95% CI 0.14–0.25%) of the women undergoing hysterectomy were found to have malignancy of the cervix uteri and the ovary, respectively. Among patients undergoing myomectomy, 0.21% (95% CI 0.03–0.40%) were found to have malignancy of the corpus uteri with no occult cervical or ovarian cancer identified.

CONCLUSION:
Prevalence of occult corpus uteri, cervical, and ovarian malignancy was 1.44%, 0.60%, and 0.19%, respectively, among women undergoing hysterectomy and it varied by patient age and surgical route.
Manual Compared With Electric Vacuum Aspiration for Treatment of Molar Pregnancy
Authors: Padrón Lilian , Rezende Filho Jorge , Amim Junior Joffre , Sun Sue Yazaki , Charry Rafael Cortés , Maestá Izildinha , Elias Kevin M. , Horowitz Neil , Braga Antonio , Berkowitz Ross S. 
Published: March 2018

OBJECTIVE:To evaluate uterine evacuation of patients with molar pregnancy, comparing manual with electric vacuum aspiration.METHODS:This is a retrospective cohort study of patients with molar pregnancy followed at the Rio de Janeiro Trophoblastic Disease Center from January 2007 to December 2016. The individual primary study outcomes were incomplete uterine evacuation, uterine perforation, development of uterine synechia, and development of postmolar gestational trophoblastic neoplasia. Secondary endpoints were other features of the perioperative outcomes (operative time, rate of transfusion, hemoglobin change, length of stay) and the clinical course of neoplasia (Prognostic Risk Score, presence of metastases, time to remission, and need for multiagent chemotherapy).RESULTS:Among 1,727 patients with molar pregnancy, 1,206 underwent electric vacuum aspiration and 521 underwent manual vacuum aspiration. After human chorionic gonadotropin normalization, patients with benign molar pregnancy were followed for 6 months and patients treated for gestational trophoblastic neoplasia were followed for 12 months. Baseline risk factors for gestational trophoblastic neoplasia and demographic features were similar between the treatment groups. Uterine synechia developed less frequently after manual vacuum aspiration than after electric vacuum aspiration, 6 of 521 vs 63 of 1,206 (adjusted odds ratio [OR] 0.21, 95% CI 0.09–0.49), despite no differences in the occurrence of incomplete uterine evacuation, 65 of 521 vs 161 of 1,206 (adjusted OR 0.93, 95% CI 0.69–1.27), development of postmolar gestational trophoblastic neoplasia, 90 of 521 vs 171 of 1,206 (adjusted OR 1.26, 95% CI 0.96–1.67), or the need for multiagent chemotherapy, 22 of 521 vs 41 of 1,206 (adjusted OR 0.81, 95% CI 0.73–1.28).CONCLUSION:Manual vacuum aspiration appears to be similar to electric vacuum aspiration for treatment of molar pregnancy and may be associated with less development of uterine synechia.
Quality Improvement to Demonstrate the Lack of Reliability of the Human Papillomavirus mRNA Assay to Identify Women With Latent Human Papillomavirus Infections
Authors: Cotton Sarah , Brown Robert E. , Nugent Elizabeth K. , Robazetti Sonia C. , Berens Pamela D. , Smith Judith A. 
Published: March 2018

OBJECTIVE:
To assess the consistency between human papillomavirus (HPV) mRNA testing in women with a history of previous HPV infections diagnosed by HPV DNA assay and the potential effects on follow-up HPV screening.

METHODS:
This was a quality improvement study that used data from a pathology laboratory software database reviewed from November 2014 to June 2016 to identify female patients aged 30 years or older with greater than one HPV-positive result, including one or more HPV mRNA assay results and one or more documented HPV DNA assay results for comparison. Previous correlative cytology and colposcopic histopathology were also documented. American College of Obstetricians and Gynecologists' cervical cancer screening guidelines were used to compare potential differences in follow-up recommendations.

RESULTS:
Four hundred twenty-five charts for female patients 30 years of age or older were identified with one or more prior high-risk HPV infections by DNA assay. There was a 69.3% difference in HPV mRNA results compared with previous HPV DNA–positive results. There was a potential change in follow-up for 71.7% of patients with one prior high-risk-HPV-positive result and 60.0% of patients with two or more prior high-risk HPV-positive results. There were 231 colposcopy reports evaluated in this study. Of these, 62 (26.8%) were abnormal colposcopy reports, including 45 low-grade squamous intraepithelial lesions, 15 high-grade squamous intraepithelial lesions, and two cancers. Twenty-five (40.3%) abnormal colposcopy findings were in patients with a history of at least than two prior HPV DNA–positive results and a report of currently being HPV-negative with the mRNA assay.

CONCLUSION:
The HPV mRNA assays are less sensitive for detection of latent HPV infections compared with HPV DNA assays. Based on these data and the potential change in follow-up care, the HPV mRNA assay should not be used for a primary screening tool for cervical cancer. Many pathology laboratories have shifted to using the HPV mRNA assay without clear discussion with gynecologists about the effects on patient follow-up. The type of HPV assay being used should be documented and any HPV mRNA result confirmed by HPV DNA assay.
Health Care Disparity and Pregnancy-Related Mortality in the United States, 2005–2014
Authors: Moaddab Amirhossein , Dildy Gary A. , Brown Haywood L. , Bateni Zhoobin H. , Belfort Michael A. , Sangi-Haghpeykar Haleh , Clark Steven L. 
Published: March 2018

OBJECTIVE:
To quantitate the contribution of various demographic factors to the U.S. maternal mortality ratio.

METHODS:
This was a retrospective observational study. We analyzed data from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics database and the Detailed Mortality Underlying Cause of Death database (CDC WONDER) from 2005 to 2014 that contains mortality and population counts for all U.S. counties. Bivariate correlations between the maternal mortality ratio and all maternal demographic, lifestyle, health, and medical service utilization characteristics were calculated. We performed a maximum likelihood factor analysis with varimax rotation retaining variables that were significant (P<.05) in the univariate analysis to deal with multicollinearity among the existing variables.

RESULTS:
The United States has experienced an increase in maternal mortality ratio since 2005 with rates increasing from 15 per 100,00 live births in 2005 to 21–22 per 100,000 live births in 2013 and 2014. (P<.001) This increase in mortality was most pronounced in non-Hispanic black women, with ratios rising from 39 to 49 per 100,000 live births. A significant correlation between state mortality ranking and the percentage of non-Hispanic black women in the delivery population was demonstrated. Cesarean deliveries, unintended births, unmarried status, percentage of deliveries to non-Hispanic black women, and four or fewer prenatal visits were significantly (P<.05) associated with the increased maternal mortality ratio.

CONCLUSION:
The current U.S. maternal mortality ratio is heavily influenced by a higher rate of death among non-Hispanic black or unmarried patients with unplanned pregnancies. Racial disparities in health care availability and access or utilization by underserved populations are important issues faced by states seeking to decrease maternal mortality.
Prevalence of Depression Among Women of Reproductive Age in the United States
Authors: Guo Nan , Robakis Thalia , Miller Claire , Butwick Alexander 
Published: March 2018

OBJECTIVE:
To describe the prevalence, use of antidepressants, and predictors of major and minor depression among nonpregnant women of childbearing age.

METHODS:
Using data from the National Health and Nutrition Examination Surveys 2007–2014, we performed a cross-sectional study of 3,705 nonpregnant women of childbearing age. The primary outcome is the prevalence of major depression, and secondary outcomes are the prevalence of minor depression, rates of antidepressant use, and predictors of major and minor depression. Major and minor depression were classified using the Patient Health Questionnaire 9. Univariate and multivariate associations between major depression and minor depression with potential predictors were estimated using multinomial logistic regression.

RESULTS:
The overall prevalences of major and minor depression were 4.8% (95% CI 4.0–5.7%) and 4.3% (95% CI 3.5–5.2%), respectively. The prevalences of antidepressant use among women with major depression and minor depression were 32.4% (95% CI 25.3–40.4%) and 20.0% (95% CI 12.9–29.7%), respectively. Factors most strongly associated with major depression were government insurance (adjusted relative risk [RR] ratio 2.49, 95% CI 1.56–3.96) and hypertension (adjusted RR 2.09, 95% CI 1.25–3.50); for minor depression, these were education less than high school (adjusted RR 4.34, 95% CI 2.09–9.01) or high school education (adjusted RR 2.92, 95% CI 1.35–6.31).

CONCLUSION:
Our analysis indicates that 1 in 20 nonpregnant women of childbearing age experience major depression. Antidepressants are used by one third of those with major depression and one fifth of those with minor depression.
Simultaneous Compared With Interval Medical Abortion Regimens Where Home Use Is Restricted
Authors: Lohr Patricia A. , Starling Jennifer E. , Scott James G. , Aiken Abigail R. A. 
Published: March 2018

OBJECTIVE:
To evaluate outcomes with simultaneous administration of mifepristone and misoprostol for medical abortion at 63 days of gestation or less in the year after its implementation in a British clinic system.

METHODS:
We conducted a retrospective cohort study using deidentified data from the electronic booking and complications databases and medical records of women who underwent medical abortion at British Pregnancy Advisory Service. Our primary outcome was treatment success with simultaneous dosing compared with a regimen with a 24- to 48-hour interval between medications. We defined success as complete abortion without surgical evacuation and without continuing pregnancy. To assess relative regimen effectiveness while accounting for self-assignment to simultaneous or interval dosing, we modeled the probability of treatment success using logistic regression with propensity score adjustment for demographic and clinical characteristics. Secondary outcomes were reasons for abortion failure and clinically significant adverse events (hospital admission, blood transfusion, intravenous antibiotic administration).

RESULTS:
Of 28,901 women treated between May 2015 and April 2016, 85% chose simultaneous dosing. Overall success rates were high with both regimens but lower with simultaneous than with interval dosing (94.5% vs 97.1%, respectively, adjusted relative risk 0.973, 95% CI 0.967–0.979). For both regimens, success rates were lower at higher gestational ages, but the relative effectiveness of simultaneous dosing did not vary significantly with gestational age (P=.268). Surgical intervention rates for continuing pregnancy were lowest at 49 days of gestation or less (1.4% simultaneous vs 0.2% interval, P<.001) and highest at 57–63 days of gestation (5.0% and 2.2%, P<.001). The rate of clinically significant adverse events was 0.2% and did not differ by regimen (P=.972).

CONCLUSION:
Simultaneous administration of mifepristone and misoprostol is 97% as effective as a 24- to 48-hour interval at all gestational ages 63 days or less with no increase in the risk of clinically significant adverse events. Pragmatic use of simultaneous dosing is reasonable given the small difference in effectiveness.