bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pan-Cancer Panel Testing: Variation in Testing and Results by Ancestry [27O]
Authors: Chalas Eva , Cummings Shelly , Larson Katie , Adkins Royce Terrell 
Published: May 2019

INTRODUCTION:
Multi-gene panels and reduced costs have allowed for greater access to hereditary cancer genetic testing. Here we assess ancestry-based differences in testing practices for individuals with and without a personal history.

METHODS:
Clinical information was obtained from provider-completed test request forms for women who had pan-cancer panel testing from 2013 to 2018 (N=427,864). The proportion of patients with a pathogenic variant (PV), family cancer history, and age at testing were evaluated for the four most common ancestries in this cohort (White/non-Hispanic, Hispanic/Latino American, Black/African, Asian). Analyses were performed separately based on personal cancer history (affected, unaffected).

RESULTS:
65.5% of individuals were unaffected (White, 64.2%; Black, 65.6%; Hispanic, 67.4%; Asian, 54.7%). Although positive rates were higher among affected individuals (9.2% to 11.5%), a substantial proportion of unaffected individuals had a PV (White, 5.2%; Black, 3.7%; Hispanic, 4.6%; Asian, 4.9%). Regardless of ancestry, family history of cancer was more common among unaffected individuals (99.0 to 99.4%) compared to affected individuals (71.2 to 91.0%). Affected women were older than unaffected women at the time of testing in the full cohort (53.2 vs 41.9 years, P<.0001) and among PV carriers (51.9 vs. 40.0 years, P<.0001). Affected, Hispanic women were the youngest at testing.

CONCLUSION:
These data demonstrate that obtaining a family cancer history for unaffected women is critical to identifying those at increased risk of carrying a PV in a cancer-predisposition gene, regardless of ancestry. The older age at testing observed for affected women may also suggest missed opportunities for earlier testing and subsequent intervention.
LARC: Looking At Retention of Contraception [2P]
Authors: Sandsmark Emilee K. , Garcia Christian , Mercer Laura , Addis Ilana 
Published: May 2019

INTRODUCTION:
The American College of Obstetricians and Gynecologists (ACOG) recommends LARC use as first line for all reproductive aged women who desire contraception, including women that are in the immediate postpartum period. There are no studies that describe the preference of Arizona women to use LARC during the immediate postpartum period and their ability to obtain their preferred contraception.

METHODS:
This was a prospective cohort study that used postpartum phone surveys at 2, 6 and 12 months to inquire about postpartum follow up compliance, contraception choice at time of delivery, and ability to achieve and maintain their method of choice.

RESULTS:
79 patients were recruited at Banner University Medical Center Tucson. During their delivery hospitalization, 49% expressed desire for a LARC. 28% received a LARC, 41% definitively did not receive one, and 31% were lost to follow up. Of those not using a LARC at follow up, only 43% were using an effective method. In those who had at least one follow up call, the pregnancy rate was 9 percent (n=5). 4 pregnancies were unintended, and 3 of these patients had desired a LARC but did not receive one. 76% of all patients reported contraception counseling prior to delivery hospitalization. Individuals who received pre-delivery discussion were twice as likely to desire a LARC at time of delivery.

CONCLUSION:
Far more individuals desire LARC than those who receive LARC. Even women who are strongly motivated to avoid pregnancy are at risk of unplanned pregnancy within the first year after delivery.
Malposition and Expulsion of Immediate Postplacental Intrauterine Devices [3P]
Authors: Bala Shruti 
Published: May 2019

INTRODUCTION:
The primary objective was to determine if immediate postpartum placement of intrauterine devices at time of cesarean delivery was associated with increased rates of malpositioned devices compared with placement after vaginal delivery.

METHODS:
This was a retrospective cohort of 126 women who received immediate postpartum intrauterine device placement (either a postplacental levonorgestrel or copper) following vaginal or cesarean delivery over a two year period between May 2015 to May 2017 at a tertiary care center. Women were followed for 12 weeks postpartum.

RESULTS:
A total of 126 women were analyzed in this study (N=63 for vaginal deliveries and N=63 for cesarean delivery). Baseline demographic characteristics between the vaginal delivery and cesarean delivery groups were similar. The total discontinuation of IUD secondary to malposition or expulsion was 33% (N=42; 25% at time of cesarean delivery versus 41% at time of vaginal delivery) at 12 weeks post-partum. Expulsion of the IUD was significantly more common in the vaginal delivery group (31.7% versus 12.7%, p=0.017). There was no difference in malposition between the two groups (9.5% in vaginal delivery group, 14.2% in cesarean delivery group, p=0.58). There was a significant increase in use of ultrasound to determine IUD position amongst the cesarean delivery group (46.0% vs. 12.7%, p=0.00003).

CONCLUSION:
Immediate post-placental IUD placement after vaginal delivery resulted in a higher occurrence of expulsion than following cesarean delivery. We did not observe a significant difference in malposition of intrauterine devices following placement after vaginal delivery compared with cesarean section.
Non-Palpable Contraceptive Implant Removals: Experience From a Referral Center [5P]
Authors: Matulich Melissa Carol , Chen Melissa Joy , Schimmoeller Natasha Rita , Hsia Jennifer K. , Uhm Suji , Creinin Mitchell D. 
Published: May 2019

INTRODUCTION:
To describe our experience as a non-palpable contraceptive implant referral center, including office removal of subfascial implants.

METHODS:
We reviewed the charts of 46 patients seen in our Family Planning subspecialty center for non-palpable contraceptive implant removal from March 2015 through August 2018. Non-palpable implants were localized using high-frequency ultrasonography and skin mapping. We extracted information on demographics, implant location, and outcomes. We used Fisher exact testing for dichotomous variables. IRB-approved.

RESULTS:
Five women had palpable implants of which four chose to have removal. Ultrasound localization was performed for the other 41 women; one was not visualized and was identified on computed tomography imaging. Implants were intrafascial (n=1), suprafascial (n=15), and subfascial (n=25). The patient with intrafascial placement chose to continue use. Two patients with a subfascial implant opted to delay removal. We completed all 15 attempted suprafascial implant removals and 19/23 (83%) attempted subfascial removals in the office. Three of the four failures had removal in the operating room with a collaborative orthopedic surgeon; the other patient sought surgical removal elsewhere. Post-procedure neuropathic pain complaints were reported after 7 (30%) subfascial and no suprafascial removals (P=.03). Non-palpable implants were subfascial in 1/8 (12%) obese and 24/33 (73%) non-obese women (P=.003). Eight (32%) subfascially located implants were inserted during a removal-reinsertion procedure through the same incision.

CONCLUSION:
At a specialized referral center, most subfascial implants can be removed in the office; some patients may experience limited post-procedure neuropathic pain. Most non-palpable implants in non-obese women are subfascial and in obese women are suprafascial.
Pain Medication Use in Opiate Dependent Patients During Surgical Abortion [6P]
Authors: Ramanadhan Shaalini , White Katharine O. 
Published: May 2019

INTRODUCTION:
There are currently limited guidelines for pain management for patients who are opiate dependent and undergoing minor surgical procedures. We assessed the differences in pain medication use for patients with and without opiate dependence and explored factors associated with need for pain medication during surgical abortion.

METHODS:
We conducted a chart review of patients undergoing surgical abortion from 2012 to 2017 at a single urban university hospital. We compared the doses of administered benzodiazepines and opiates for patients who were opiate dependent to a random sample of non-opiate dependent women undergoing the same procedures. We assessed associations of opiate replacement therapy use and outpatient pain medication.

RESULTS:
We identified 64 women with opiate dependence who met eligibility criteria. The mean fentanyl dose was higher for opiate dependent (n=64) than non-dependent (n=64) patients (110 mg vs 88 mg, p=<0.001). Average midazolam doses were only minimally different between groups (2.7 mg and 2.3 mg, p=0.001). Within the opiate dependent cohort, use of replacement therapies such as methadone (n=17) or buprenorphine (n=28) did not impact pain medication requirements.

CONCLUSION:
Higher doses of fentanyl may be required to achieve adequate pain control for patients with opiate dependence during surgical abortion. The use of replacement therapy does not impact dosing. These findings can inform provider expectations related to doses of narcotics for opiate dependent patients.
Evaluation of Neonatal Resuscitation Program (NRP) Knowledge Among OB/GYN Residents [11P]
Authors: Tonismae Tiffany R. , Slaven James E. , Shanks Anthony L. 
Published: May 2019

INTRODUCTION:
NRP training has been utilized to teach birth attendees evidence-based approaches to care for the newborn at birth. OB/GYN trainees undergo NRP training and rotate in the NICU as interns. It is unclear how much NRP knowledge is retained as OB/GYN residents advance in NRP knowledge following their intern NICU rotation and NRP course.

METHODS:
A survey was distributed amongst the 41 OB/GYN residents at Indiana University during the 2017-2018 academic year following IRB approval from Indiana University School of Medicine. The survey was completed anonymously and included the resident's year in training (PGY1-4) and date of their NRP course and NICU rotation. A 10-question abbreviated NRP quiz was administered to participants. Correlation analysis was performed to test for associations between quiz scores and elapsed time (months) between quiz and the intern NRP course and NICU rotation.

RESULTS:
37 of 41 residents completed the survey. The average test score was 76%. There was no significant difference between abbreviated NRP quiz score and PGY level (p=0.30). There was also no difference between time since NRP course (p=0.21) or time since NICU rotation (p=0.50). Greater time since NICU rotation correlated with lower quiz scores in the PGY2 class (p<0.05). No significant correlation was seen in the other classes.

CONCLUSION:
Overall, there was no significance between test scores based on training year. With this information, OB/GYN residents may be able to do an accelerated certification course while in a training setting instead of the traditional course completion every 2 years.
Residents at Inner-City Academic Centers May Fail to Meet the New Minimally Invasive Hysterectomy Requirements [14P]
Authors: Sidduri Nishanth , Ackroyd Sarah , Hernandez Enrique , Rose Marisa 
Published: May 2019

INTRODUCTION:
The ACGME and ACOG promote the use of minimally invasive approaches for hysterectomy. In 2018, the ACGME Ob/Gyn Residency Review Committee increased the number of minimally invasive (MIS) hysterectomies required for trainees to graduate residency. Historically, inner-city black women have higher rates of fibroid disease and other medical co-morbidities that may exclude MIS as the safest mode for hysterectomy.

METHODS:
Retrospective cohort study using the 2016 hysterectomy-specific National Surgical Quality Improvement Program (NSQIP) database. Demographics, comorbidities and surgical characteristics were examined by hysterectomy type. The association between race and hysterectomy type was investigated using one and two-way analysis of variance (ANOVA).

RESULTS:
In 2016, 20,770 hysterectomies for benign indications were identified. Across all races, 25.7% underwent abdominal hysterectomy, 57.4% underwent laparoscopic hysterectomy and 16.9% underwent vaginal hysterectomy. Black women were more likely than white women to undergo open abdominal hysterectomy (41.4% vs 20.1%, respectively, P<0.001). After adjusting for uterine weight (0-100 g, 100-250 g, and >250 g), black women were still more likely to undergo abdominal hysterectomy compared to other races (P<0.001). Additionally, when adjusting for history of prior abdominal or pelvic surgeries, black women were more likely to undergo abdominal hysterectomy compared to other races (P<0.001).

CONCLUSION:
Black women disproportionately undergo higher rates of abdominal hysterectomy compared to other racial groups. Trainees at academic medical centers with a higher proportion of black patients may fail to meet the number of minimally invasive hysterectomies required for graduation. Further efforts to identify the etiology of racial disparities in route of hysterectomy should be pursued.
STEP 1, STEP 2 or CREOG Scores- Which Exam Predicts Successful Passage of the Qualifying Examination? [15P]
Authors: North Ware Jamie L. , Tabatabai Mohammad , Im Wansoo , Fritts Demeka , Looney Kimberly , Aguinaga Maria del Pilar 
Published: May 2019

INTRODUCTION:
The Council on Resident Education in Obstetrics and Gynecology (CREOG) is an objective measurement of medical knowledge. A score below 200 may identify those at risk for failing the American Board of Obstetrics and Gynecology (ABOG) Qualifying Exam. The aim of this study is to evaluate if there is a correlation between the Step 1, 2 (CK) and CREOG scores collectively with the passage of the ABOG Qualifying Exam on the first attempt and to identify a threshold score for passage.

METHODS:
IRB approval was waived and data collected from twenty-seven residents over a ten year period. For each resident, the STEP 1, STEP 2, annual CREOG scores and self-reported passage of the ABOG Qualifying Exam were collected. Residents with missing data (n=2) were excluded. Simple logistic regression was used to investigate the effect of a single test score on predicting the likelihood of pass or fail on the ABOG Qualifying Examination. The associations between the examinations were evaluated using Spearman's rank correlation coefficient.

RESULTS:
USMLE Step 1 and Step 2 examinations had no significant effect on the outcome of the ABOG Qualifying examination (P<0.125 and P<0.544) respectively. PGY2 was a better predictor when compared to the PGY1 scores (P<.079) vs (P<.611). The mean score was 178.444 for PGY 3 and was the most significant factor in predicting passage or failure of the Qualifying Examination (P<.031).

CONCLUSION:
A score of 170 or higher on the last two years of residency might be a good indicator of success on the ABOG Qualifying Examination.
Transgender Care Knowledge and Attitudes Amongst Puerto Rico's Gynecologists [18P]
Authors: Carro-Jimenez Maria T. , Ortiz Kevin J. , Rivera Mario , Suárez Gina , Romaguera Josefina 
Published: May 2019

INTRODUCTION:
Transgender refers to individuals whose gender identity and/or expression of gender differs from gender assigned at birth. Countless roadblocks prevent access to medical services due to stigmas and prejudices, lack of knowledge and experience in terms of their healthcare needs, and insensitive treatment from their providers. Even though the gynecology field is involved in care of transgender individuals, there is scarce literature and guidelines focused on their care. The aim of this study is to learn about attitudes, disposition and knowledge of transgender medical care amongst gynecologists actively practicing in Puerto Rico (PR).

METHODS:
After Institutional Review Board approval, gynecologists were invited to complete a survey designed to determine knowledge about transgender care, disposition, and experience treating transgender patients. The administered questionnaire was previously used in a study evaluating gynecologists from the continental United States but had yet to be done in PR. Responses were catalogued using Epi Info frequency analysis.

RESULTS:
Fifty-nine participants were recruited. When asked if comfortable taking care of male-to-female transsexuals (MTFT), 59% agreed. In female-to-male transsexuals (FTMT), 47% agreed. Regarding if would perform pap smears on FTMT 81% agreed, whereas 80% felt comfortable performing breast exams on MTFT. Of the respondents 49% are not familiar with hormonal regimens used for gender reassignments. 70% of respondents knew there is a Practice Bulletin on the care of the transgender patient.

CONCLUSION:
There is a willingness to treat transsexual patients amidst PR gynecologists but the lack of knowledge regarding population specific treatments and managements represents a limitation.
Self-Reported Opioid Allergy: Obstetrical Outcomes and Postpartum Pain Management [29P]
Authors: Blitz Matthew J. , Freling Julia L. , Prasannan Lakha , Greenberg Meir , Marchbein Harvey , Rochelson Burton L. 
Published: May 2019

INTRODUCTION:
To determine how obstetrical outcomes and inpatient postpartum pain management are affected by self-reported opioid allergy (SROA).

METHODS:
Retrospective cohort study of singleton deliveries at >=37 weeks of gestation at a tertiary hospital from 2013-2016. Patients were excluded for NSAID allergies, drug abuse history, positive urine toxicology, general anesthesia for delivery, and incomplete records. The primary outcomes evaluated were mode of delivery and medications administered for inpatient postpartum analgesia.

RESULTS:
A total of 21,225 deliveries were included: 289 with SROA and 20,936 without SROA. In the SROA group, 29 reported reactions suggestive of true allergies (i.e. severe, life-threatening, hypersensitivity reactions). Among this subgroup, 51.7% (n=15) received opioids from the same chemical class (phenanthrenes) as their stated allergy. Women in the SROA group were older and more likely to be white and multiparous. The SROA group had a higher primary cesarean delivery rate (36.0% vs. 21.7%; P<0.0001) and overall cesarean delivery rate (58.1% vs. 35.3%; P<0.0001). Among cesarean deliveries, there was a small reduction in inpatient postpartum opioid analgesia in the SROA group compared to the non-SROA group (73.8% vs. 80.5%, respectively; P<0.04); no difference was noted among vaginal deliveries. Women in the SROA group who received opioids were more likely to receive multiple opioid medications (15.1% vs. 8.2%; P<0.005).

CONCLUSION:
True opioid allergy is rarely encountered in obstetrics. Women with SROA receive inpatient postpartum opioid analgesia at similar rates to those without SROA. Patients prone to adverse medication effects may be at increased risk for cesarean delivery.
Severe Anemia at Delivery: Can Rigorous Antenatal Identification Prevent It? [30P]
Authors: Fadayomi Ayotunde , Reimers Rebecca Mutascio , Smith Nicole A. , Carusi Daniela A. 
Published: May 2019

INTRODUCTION:
Despite routine antenatal hemoglobin (Hb) assessment, severe anemia at delivery remains a problem. We evaluated whether attentiveness to anemia is associated with less severe anemia at delivery.

METHODS:
This is a nested case-control study derived from deliveries at an academic tertiary hospital from January, 2007 to May, 2016. We identified patients with a singleton gestation and Hb ≤10.5 g/dl between 12 and 29 weeks gestational age, excluding suspected accreta, previa, hemoglobinopathies or relevant chronic medical conditions. Severe anemia was defined as Hb ≤9 g/dl at time of delivery. Controls were matched 2 to 1 by delivery year. We compared the use of supplemental lab evaluations and iron prescriptions for the two groups.

RESULTS:
Of 60,274 deliveries, 2,623 patients had second trimester anemia. Of these, 168 (6.4%) presented with severe anemia at delivery. After matching, 504 patients were analyzed. On univariate analysis, cases were more likely to be black (OR 1.76, P=.02) or Hispanic (OR 1.85, P=.02), multiparous (OR 2.76, P<.0001), have lower mean second trimester Hb (9.2 g/dl vs 10.0 g/dl, P<0.0001), have additional Hb (20.8% vs 10.1%, P=.002) and ferritin draws (8.9% vs 2.4%, P=.002), supplemental iron prescriptions (58.3% vs 0.9%, P<.0001), and iron infusions (6% vs 0%, P<0.0001) than were controls. On multivariate analysis, cases still had more supplemental labs (OR 2.60; P=0.0004), and oral/IV iron prescriptions (OR 66.86; P<0.0001).

CONCLUSION:
Severe anemia at delivery was not associated with reduced attentiveness to low antenatal hemoglobin. Prevention should focus on alternative treatment approaches.
Severe Range Blood Pressures and the Association With Hypertension Up to 2 Years Post-Delivery [31P]
Authors: Leftwich Heidi Kay , Weeks Corinne M. , Marcov Lauren J. , Wiese Sarah L. , Chase Gillian , Leung Katherine 
Published: May 2019

INTRODUCTION:
While hypertension can normalize soon after delivery, some women experience prolonged periods of hypertension. We sought to determine whether severe range blood pressures on labor and delivery are associated with having hypertension 12 weeks to 2 years after delivery.

METHODS:
Retrospective cohort study of pregnancies with a delivery from 7/2009-7/2016. Inclusion criteria were delivery at our tertiary hospital, presence of hypertensive disorder, and a documented blood pressure 12 weeks-2 years postpartum. Blood pressures were documented for every visit between 12 weeks and 2 years postpartum. A logistic regression model was used to determine the odds of hypertension in the 2 years following delivery. Multivariable logistic regression analysis was used to adjust for confounding factors.

RESULTS:
524 women met inclusion and exclusion criteria. Of these, 127 (24%) women had at least one severe range blood pressure during their hospitalization for delivery. Women with severe blood pressures were more likely to have a history of or current gestational hypertension, but less likely to have IUGR (p<0.05). Other variables were similar. However, women with severe range blood pressures during delivery hospitalization did not show a greater rate of hypertension from 12 weeks - 2 years in either unadjusted (OR 1.24 [0.83-1.85], p=0.30) or adjusted analysis (OR 1.24 [0.80-1.9], p=0.34).

CONCLUSION:
While 24% of women in our cohort had severe range hypertension, this was not associated with hypertension up to 2 years post-delivery. It is important to encourage all women with hypertensive disorders to follow up closely, as this alone does not seem to identify those at highest risk.