bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessment of HPV Vaccination Compliance Rates Among Gynecology Providers: An Institutional Study of 845 Patients [24M]
Authors: Schneiter Mali , Elsamadicy Emad A. , Mehta Sumit 
Published: May 2019

INTRODUCTION:
Identifying the drivers of noncompliance is necessary to better overall patient care and utility of the HPV vaccine. The primary aim of this study is to assess the compliance rates with HPV vaccination rates amongst gynecological (GYN) providers and has it improved over time.

METHODS:
The medical records of 845 women patients who were administered the HPV vaccine series by a GYN provider were retrospectively reviewed from 2006-2010 and 2014-2015. Patients were grouped by date of vaccine initiation, whether “Earlier” (2006-2010) or “Later” (2014-2015) cohorts. Patient demographics, dates of vaccine administration, and practice where vaccines were administered were collected on each patient. Patients who received all 3 vaccines within 6 months were deemed compliant. The primary outcome was the compliant rates.

RESULTS:
845 patients were reviewed, (Earlier: n=399, Later: n=475). The mean ages at initiation were similar between the cohorts (Earlier: 22.0 years vs. Later: 22.3 years, P=.16). The Later-cohort trended to have a lower compliant rate than the Earlier-cohort (Earlier: 35.2% vs. 30.9%, P=.20). Amongst patients in the Later cohort, the ages at initiation were similar between the two cohorts (p=.61). There was a significant difference between the compliance rates among the different Races (P=.036), with African-American (18.9%) and Hispanic (20.00%) patient-populations having lowest compliance rates.

CONCLUSION:
Our study found that there was no significant increase in HPV vaccination compliance rates among GYN patients over time. Additionally, our study suggests that race may have a role in vaccine compliance. Further studies are necessary to identify risk factors and independent predictors of non-compliance.
Does Remote Monitoring of Blood Glucose Levels During Pregnancy Expedite Time to Intervention? [25M]
Authors: Leggett Kelly , Hutchinson Mandy , Paddock Beverly , Rassette Kelly , Rider Cal 
Published: May 2019

INTRODUCTION:
Patients with diabetes mellitus monitor blood glucose levels throughout their pregnancy to determine if intervention is required. Traditional paper recording only allows readings to be reviewed during visits. The aim of this study is to determine if remote monitoring of blood glucose levels through a mobile application increases the availability of data and allow providers to expedite intervention.

METHODS:
Women with gestational diabetes mellitus or pre-existing diabetes mellitus were invited to participate in the remote monitoring program. Patients received Babyscripts, a mobile application with a digital glucose log, and were asked to enter fasting and postprandial glucose levels. Physicians used a web portal to monitor patients' glucose logs. The physician's office was also contacted for triggers needing immediate attention. These thresholds were as follows: Fasting CBG < 60 mg/dl or >150 mg/dl or postprandial >250 mg/dl. Offices were also notified if 7 or more elevated readings occurred during alone week period (fasting >96 mg/dl, or postprandial >120 mg/dl).

RESULTS:
Eighteen pregnant women were offered the program and 17 agreed to be enrolled. A total of 1304 glucose levels were recorded by 17 patients. Providers were alerted 60 times to review abnormal values.

CONCLUSION:
Remote monitoring of blood glucose levels resulted in an increased availability of data for providers outside of the scheduled visit setting. Trigger protocols improved the provider's response times to both hypo- and hyperglycemia. Noncompliance was also quickly identified. Further research is needed to determine if the availability of blood glucose levels impacts maternal health and birth outcomes.
Use of a Targeted Lynch Syndrome Next Generation Sequencing Panel in Women at Risk for or With Endometrial Cancer [32M]
Authors: Padron Maria Mercedes M. , Camacho-Vanegas Olga , Pandya Deep , Camacho Sandra Catalina , Dottino Peter , Martignetti John A. 
Published: May 2019

INTRODUCTION:
Women with endometrial cancer should be screened for Lynch syndrome (LS), a hereditary cancer syndrome caused by germline mutations in DNA mismatch repair (MMR) genes. This information directly affects immediate clinical management including future risk reducing/surveillance strategies for patients and at-risk family members. It is currently unclear how best to provide molecular screening. We investigated the use of a newly developed, targeted next generation sequencing panel (NGS), requiring only low input amounts of DNA, in a cohort of patients referred to a Gynecology Oncology clinic.

METHODS:
All patients included in this IRB-approved study were either being treated for endometrial cancer or being evaluated for risk. Germline/tumor DNA was isolated and 10ng DNA was used for targeted exon-level hotspot coverage of four genes, MLH1, MSH2, MSH6 and PMS2, using Swift's Accel-Amplicon Plus Lynch Syndrome Panel.

RESULTS:
Prior to patient sample analysis, the panel was shown to exhibit >90% on target and >90% coverage uniformity using 10 DNA control samples. The workflow allowed us to move from library preparation to data analysis within 2 days. All germline patient samples were found to possess either an insertion, deletion or single nucleotide variant predicted to inactivate either MSH2, MSH6 or MLH1. Paired tumor samples possessed the same MMR mutations. No inactivating PMS2 mutations were identified. All results were validated against commercially-available gene tests.

CONCLUSION:
A targeted NGS panel rapidly identified both germline and somatic Lynch syndrome pathogenic mutations. This panel provides an additional molecular tool for identifying women with this hereditary cancer syndrome.
Identifying Barriers to Postpartum Tubal Ligation: A Retrospective Chart Review [3N]
Authors: Ka Ng June Hoi , Esguerra Cybill Ruth , Ho Diana Yau , Patel Jharna M. , Amico Jennifer 
Published: May 2019

INTRODUCTION:
Tubal ligation is the second most common method of contraception in the United States and is also one of the most effective, with a failure rate of 1.85% over 10 years. However, multiple barriers to postpartum bilateral tubal ligation (ppBTL) exist, including Medicaid paperwork, physician concern for regret, lack of facilities or staff, and cost. Some of these risk factors affect women of low socioeconomic status disproportionately.

METHODS:
To identify barriers to completion of ppBTL, we conducted a retrospective chart review over 18 months of all patients (n=645) who desired ppBTL on admission to labor and delivery at an academic institution in New Jersey.

RESULTS:
Overall ppBTL completion rate was 81.2%. Completion of ppBTL after vaginal delivery was 73.3% and completion rate after Cesarean delivery was 93.1%. The three most common reasons for non-completion of ppBTL were a patient changing her mind (44 patients, 36%), not documented (28 patients, 23%), and inability to access the Fallopian tubes (10 pts, 8.3%). Of the non-completed ppBTLs, 7 patients returned to our institution with a subsequent pregnancy (5.8%). While 41.5% of patients from our Federally Qualified Health Center that desired ppBTL did not receive it, only 7.3% of private patients that desired ppBTL did not receive it.

CONCLUSION:
Overall, completion rates of ppBTL at our institution are reassuring. However, we identified a disparity in completed tubal rates in our uninsured vs. insured population. Whether it is improving patient counseling antepartum or improving documentation postpartum, additional efforts are needed to improve these rates.
Reports of Sexual Violence Among Lesbian, Bisexual, and Heterosexual Women in Puerto Rico [13N]
Authors: García-Crescioni Keyla B. , Roura-Monllor Jaime A. , Frontera-Hernández Mariana , Romaguera Josefina 
Published: May 2019

INTRODUCTION:
Sexual violence (SV) is a highly prevalent public health issue that affects a person's physical and emotional health. In the United States, approximately 36.3% of women report SV. A history of SV has been associated with increased mental disorders, substance abuse, criminal activity, and high-risk sexual practices. In Puerto Rico (PR), the Department of Health informed that SV was most commonly reported in girls aged 10 to 14 years.

METHODS:
This was a secondary data analysis of an anonymous web-based questionnaire given to 476 women in PR. The study variables were history of SV and age of first sexual experience. The data was grouped by sexual orientation and analyzed using chi-square testing. A P-value < .05 was considered significant.

RESULTS:
Sociodemographic characteristics were similar between groups except for age. The most common age of first sexual experience was between 7 and 12 years and was not significantly different between groups. The SV question was answered by 392 (82.4%) of participants. Of these, 18.1% heterosexual, 12.2% lesbian, and 34.7% bisexual women reported SV. Bisexual participants were significantly more likely to disclose a history of SV (P = .007). Overall 19.1% of participants reported SV.

CONCLUSION:
In this study a majority of women stated having a sexual experience at a young age. Significant amounts reported SV at least once in their lifetime with bisexual women being the most likely. Screening for sexual violence must be routinely performed by health professionals in order to provide counseling to its victims.
Knowledge, Attitudes and Perceptions About Medicolegal Education: A Survey of OB/GYN Residents [17N]
Authors: Mathew Shilpa , Ramm Olga , Cooksey Christie , Samant Navendu D. 
Published: May 2019

INTRODUCTION:
The practice of obstetrics and gynecology (OB/GYN) is inextricably linked to tort liability in the United States (US). Nationally, 40-50% of OB/GYN physicians have altered their practice due to professional liability insurance demands or fear of litigation. Despite the pervasiveness of medicolegal concerns, formal instruction on these topics has not been widely adopted in residency training and many residents may lack pertinent knowledge to prepare them for practice.

METHODS:
All US OB/GYN residents during the 2017-2018 academic year were invited by email or in person to complete an anonymous survey on their demographics, medicolegal knowledge, medicolegal education within their respective residency programs, and the impact potential litigation has on their practice plans. This study was deemed exempt by the institution's IRB.

RESULTS:
Of the 5,152 OB/GYN residents invited to complete the survey, 17% (n=865) responded. Of these, 44% (n=378) reported receiving no medicolegal education during residency, 21% (n=181) were unsure, and 34% (n=293) reported receiving some formal education. Sixty-five percent (n=549) reported receiving medicolegal education by "word of mouth" or by "observing colleagues." Sixty percent (n=500) could not identify malpractice as a form of tort liability. In describing their exposure to medicolegal topics, 67% (n=571) did not feel they had adequate exposure and 19% (n=163) were unsure. Ninety-two percent (n=782) of residents reported concerns of being sued and 67% (n=571) believed that formal instruction during residency training may prevent lawsuits.

CONCLUSION:
OB/GYN residents report inadequate exposure to medicolegal topics and desire more formal instruction during residency.
Maternal Risk Factors Associated With Persistent Placenta Previa [27N]
Authors: King Luke , Nordberg Cara , Mackeen Awathif D. , Paglia Michael J. 
Published: May 2019

INTRODUCTION:
The purpose of our study is to identify maternal characteristics that are associated with increased likelihood of placenta previa persisting to delivery.

METHODS:
We performed a retrospective, cohort study of 695 women diagnosed with placenta previa between 17 and 24 weeks gestation, who delivered at a Geisinger Health System facility from 2002 to 2016. Variables of interest included age, BMI, race, smoking status, substance abuse, parity, multigravida status, history of cesarean section, history of dilation and curettage, and history of placenta previa in prior a pregnancy. Logistic regression techniques were used for statistical analysis, P-values <0.05 considered significant.

RESULTS:
Of the 695 cases of placenta previa reviewed, a total of 368 cases were deemed complete placenta previa and the remaining cases were low-lying placentas. A total 63 (17.1%) women with complete placenta previa in the second trimester persisted to 36 weeks 0/7 days gestation requiring cesarean section. In the women diagnosed initially with complete placenta previa, a history of cesarean section (P<.001), history of dilation and curettage (P=.004), and multigravida (P<.001) were statistically significant, univariately. Other variables of interest were found not to be statistically significant. In a multivariate regression model, history of cesarean section and history of dilation and curettage remained significant with odds of persistent placenta previa (PPP) 7.0 (95% CI 3.72-13.07) and 2.5 (95% CI 1.27-5.01), respectively.

CONCLUSION:
Women diagnosed with complete placenta previa in the second trimester with a history of cesarean section and dilation and curettage are significantly more likely to have PPP.
Maternal Weight Gain and Risk of Cesarean Delivery in Women With Class III Obesity [28N]
Authors: Reiff Emily S. , Tucker Ann Robin , Brown Haywood L. , Gatta Luke , Adkins Lamani , Dotters-Katz Sarah Kathleen 
Published: May 2019

INTRODUCTION:
Class III obesity is an independent risk factor for cesarean delivery (CD). Current Institute of Medicine (IOM) guidelines recommend 11-20lbs of gestational weight gain (GWG) in women with obesity. We evaluated the association between GWG and mode of delivery in women with Class III obesity.

METHODS:
Retrospective cohort study of women who delivered a liveborn neonate at term at a single institution from 7/2013-12/2017 with a baseline BMI ≥40 in the first trimester. Pregnancies complicated by prior CD, multiple gestation, or fetal anomalies were excluded. Primary outcome was CD. Demographics, pregnancy & delivery characteristics of women who gained more than 20lbs (mIOM) were compared to women who gained ≤20lbs (lIOM) using bivariate statistics. Multivariable analysis using stepwise backward-elimination approach and planned sub-analysis of multiparous women was performed.

RESULTS:
Of 298 women, 113 (37.9%) gained mIOM. Women in the mIOM group were more likely to be nulliparous, have a lower initial and higher delivery BMI, and higher birthweight. The CD rate was 40.7% in the mIOM group and 27.5% in the lIOM group (p=0.02, OR=1.80, 95% CI 1.10, 2.96). When adjusted for multiparity, birthweight and BMI at delivery, the aOR for CD was 1.00 (95% CI 0.56, 1.76). In subanalysis of multiparous women, the OR for CD in the mIOM group was 2.54 (95% CI 1.07, 6.07). When adjusted for BMI at delivery, the aOR for CD was 0.71 (95% CI 0.16, 3.10.

CONCLUSION:
An association between excess GWG and CD in women with Class III obesity may exist, though influenced by additional risk factors.
Measuring Meconium Aspiration Syndrome With Discharge Data [31N]
Authors: Thornton Patrick D. , Campbell Richard , Mogos Mulubrhan 
Published: May 2019

INTRODUCTION:
Discharge data (International Classification of Diseases ICD codes) have not been used to estimate population level incidence of meconium aspiration syndrome (MAS) in the U.S. Existing population estimates are at least 15 years old and based on vital statistics data which are no longer collected. Estimates from other nations have used combined and disparate ICD codes (“with” and “without” respiratory symptoms).

METHODS:
We compared MAS diagnoses “with” and “without” respiratory symptoms using nationally representative newborn hospital discharges 2010-2012 (Nationwide Inpatient Sample-KIDS data). We compared incidence and outcomes of each MAS diagnosis controlling for demographic and hospital characteristics.

RESULTS:
Incidence of MAS with symptoms was 2.49/1000; 1.15/1000 without symptoms. Almost 1/3 (32%) of MAS cases identified by ICD codes were “without respiratory symptoms.” Odds ratio of MAS with symptoms was 1.54 (95% C-I 1.39-1.73) for African American newborns compared to whites. Length of stay was nearly twice as long (6.68 versus 3.65 days) and total charges were nearly 3 times higher ($44,000 versus $15,461) for newborns with symptoms than those without. Crude and adjusted OR's for hypoxic ischemic encephalopathy, pulmonary hypertension of the newborn, facility transfers and mortality are attenuated when disparate ICD codes are combined compared to cases “with symptoms” alone.

CONCLUSION:
ICD codes for MAS represent very different diseases or disease severity. Discharge data is useful in providing population estimates of MAS incidence, but diagnosis severity should be clearly distinguished by researchers. Combining disparate MAS diagnoses misrepresents incidence and disease severity, complicating population level comparisons and prevention strategies.
Missed Postpartum Venous Thromboembolism: A National Analysis of Different Hospital Readmission [33N]
Authors: Kedar Wenche , Parreco Joshua , Coll Alison Simone , Curry Christine Lynette , Rattan Rishi 
Published: May 2019

INTRODUCTION:
Venous thromboembolism (VTE) causes morbidity and mortality after delivery and is a quality indicator. Prior studies have found that readmission to a different hospital can be significant and hidden, with unique risk factors. The national rate of postpartum different hospital readmission for VTE is unknown. The purpose of this study was to calculate the rate of missed postpartum VTE.

METHODS:
The 2014 Nationwide Readmissions Database was queried for patients >14 years with a delivery hospitalization. Outcomes included: 30-, 60-, and 90-day readmission with VTE to index and different hospitals. Multivariate logistic regression identified risk factors.

RESULTS:
Of the 3,718,711 patients queried, VTE readmission rate was 0.046% (n=1,729), 0.053% (n=1,972), and 0.055% (n=2,047) at 30-, 60-, and 90-days, respectively. Patients were readmitted to different hospitals 27.13%, 29.01%, and 29.70% of the time at 30-, 60-, and 90-days, respectively. Risk factors for different hospital readmission for VTE at 60-days were unique compared to index hospital VTE readmission risk factors and included initial admission to a for-profit hospital (OR 1.80 [1.33-2.42], p<0.01) and Medicaid (OR 1.33 [1.06-1.66], p=0.01). Initial admission to a public hospital decreased the likelihood of different hospital readmission for VTE (OR 0.69 [0.49-0.97], p=0.04).

CONCLUSION:
Nearly one in three postpartum VTEs are missed by current quality metrics, with significant implications for outcomes and quality. For-profit hospitals have more VTE readmissions hidden, falsely lowering their readmission rates relative to public hospitals. Women who are publicly insured are at higher risk for disruption of their continuity of care.
Obesity in Pregnancy Patient-Reported Outcomes: A Qualitative Meta-Synthesis [40N]
Authors: Dadouch Rachel , Hall Chelsea , D'Souzoa Rohan D. 
Published: May 2019

INTRODUCTION:
Patient-reported outcomes are infrequently reported in obesity (BMI>30 kg/m2) in pregnancy trials, compromising patient-centered care. Our primary objective was to meta-synthesize qualitative results, to determine outcomes reported by these women that may inform research and clinical practice.

METHODS:
MEDLINE, Embase, CINAHL, PubMed and grey literature were searched from inception to June 2018, identifying English-language qualitative studies of women with obesity in pregnancy. Results were screened and reference lists of included studies were searched. Study characteristics were extracted, followed by a thematic synthesis, in which patient-reported outcomes were identified according to the Core Outcome Measures in Effectiveness Trials' definition. Outcomes were categorized into the taxonomy of outcomes in medical research (Dodd et al.).

RESULTS:
Of 101 results, 27 studies were included. The following themes emerged: Perceived Barriers and Benefits of Interventions, Emotions, Fears or Concerns, Social Support, Healthcare Provider Support, Size-Related Experiences (Psychosocial and/or Obstetrical), and Concerns Regarding Medical Care, Equipment and/or Environment. No study specifically aimed to determine outcomes, thus only nine outcomes were explicitly identified and the rest were synthesized from findings. Emotional Functioning/Well-being and Delivery of Care were the most frequent categories in the outcome taxonomy, while outcomes in Mortality/Survival and Physiological/Clinical and Resource Use were least highlighted.

CONCLUSION:
Identified outcomes may inform future research and clinical practice, as they vary from outcomes currently reported in clinical trials. Furthermore, the limited number of measurable outcomes in qualitative studies highlights the need for future qualitative research that specifically aims to elicit patient-reported outcomes that can be measured in clinical trials.
Knowledge and Use of Contraception Among a Population of Female Survivors of Torture [1A]
Authors: Rajeev Pournami , Bach Sonya Chemouni , Chessky Anna , Goddard Brian , Torresan Mirella , Ades Veronica 
Published: May 2019

INTRODUCTION:
Bellevue Hospital's Program For Survivors of Torture (PSOT) sees patients applying for asylum from developing countries with limited access to contraception. The objective of this study is to examine contraceptive knowledge and use among a population of asylum candidates, in order to better understand their contraceptive educational needs.

METHODS:
An observational study was conducted using a cross-sectional structured interview questionnaire. IRB approval and patient informed consent were obtained. Data were collected from 55 participants as part of a larger research study to assess histories, perceptions, and gynecological needs of immigrant female survivors of torture. Data analysis was conducted via REDCap.

RESULTS:
Sixty-three percent of participants did not want to get pregnant within the next year, but only 32% of them were using any form of effective contraception. The only effective method of contraception that a majority (53%) of participants had been taught to use were oral contraceptive pills (OCPs) and only 36% had knowledge about long-acting reversible contraceptives (LARCs). Comparatively, 75% knew how to use the rhythm method. Prior use of LARCs, OCPs, and non-effective methods were 9%, 31%, and 63%, respectively.

CONCLUSION:
A majority of the immigrant women in this study did not want to get pregnant in the next year, but a minority had knowledge about effective contraceptive options outside of OCPs, and an even fewer had knowledge about LARCs. The discrepancy of usage between non-effective methods of contraception and effective methods suggests providers who see patients entering the American healthcare system should provide education on effective contraceptive options.