bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Long Term Safety and Efficacy of the FemTouch for the Treatment of Vulvovaginal Atrophy in Postmenopausal Women [20M]
Authors: Eder Scott Evan 
Published: May 2019

INTRODUCTION:
Fractional CO2 lasers have been shown to provide improvement in vulvovaginal atrophy (VVA) in our previous study. (Eder, SE, Laser Therapy, 2018 March 31; 27(1):41-47) The aim of this extension study was to assess the long term safety and efficacy of a fractional CO2 laser system in treating VVA.

METHODS:
Twenty healthy post-menopausal women (mean age 60± 6.34 years) with VVA-related symptoms and previous fractional CO2 laser treatments (total of three at 4-week intervals) were enrolled after IRB approved consent obtained. Subjects were followed for 18 months after final treatment. At each visit, Vaginal Health Index Scores (VHIS) and VVA symptom severity was recorded. Sexual function was assessed using the Female Sexual Function Index (FSFI).

RESULTS:
At 12 months following laser treatment the mean VHIS score was significantly improved (16.3 ± 4.5 vs. baseline 12.4 ± 4.0; p<0.05), and improved further at 15 and 18 months (16.9 ± 4.6 and 17.1 ± 4.6, respectively). Almost all VVA symptoms were significantly improved at 12-months. A further significant improvement in VVA symptoms was noted at 15 and 18 months following the third and final laser treatment. The FSFI score increased significantly at the 12 month follow up visit and remained significantly higher than baseline at the 18 months follow-up visit (25.8 ± 6.6 vs. baseline 1.69 ± 7.9; p<0.05).

CONCLUSION:
CO2 laser therapy for post-menopausal women can be considered a safe and effective therapeutic option providing long term relief of menopausal vulvovaginal symptoms.
Using a Shared Decision Making Tool to Clarify Patient Preference for Treatment Options of Menopausal Symptoms [21M]
Authors: Dayaratna Sandra , Powell Rhea , Gould Rebecca , Sifri Randa , Sherif Katherine , Myers Ronald 
Published: May 2019

INTRODUCTION:
Decision counselling may prepare women for shared decision making about menopausal symptom treatment.

METHODS:
Women reporting menopausal vasomotor symptoms or genitourinary syndrome of menopause (GSM) were referred and consented. A nurse educator led a decision counselling session comprising review of an educational brochure and an online tool to clarify treatment preferences. Treatment options included non-hormone treatment vs. systemic hormones for vasomotor symptoms and non-hormone treatment vs. topical hormone treatment for GSM. Patients and their providers received a preference summary. Frequency of preferred treatments were calculated. An endpoint survey assessed participant perception of their preparation to discuss treatment options with their providers.

RESULTS:
A total 36 women with GSM (N=18) or vasomotor symptoms without a contraindication to systemic hormone therapy (N=18) completed a decision counseling session. Of these, 25 completed the endpoint survey. Among women with vasomotor symptoms, 6 (33%) preferred non-hormone treatment, 7 (39%) preferred hormone treatment, and 5 (28%) had an equal preference for these options. Among women with GSM, 6 (33%) preferred non-hormone treatment, 7 (39%) preferred topical hormone therapy, and 5 (28%) had an equal preference for these options. Ninety-six percent (24/25) felt the decision counseling session helped prepare them to discuss treatment options with their provider.

CONCLUSION:
After a decision counselling session, 72% percent of women with menopausal symptoms expressed a clear preference for a particular treatment and 96% felt more prepared to discuss treatment options with their provider. Decision counselling may add value to care of menopausal women. Further research should evaluate impact on the subsequent office visit.
Effect of Insurance Type on Patient Access to Outpatient Gynecologic Care [26M]
Authors: Zhang Jenny , Weerasooriya Nimali , Cagino Kristen , Griffin Todd 
Published: May 2019

INTRODUCTION:
One purpose of the Affordable Care Act (ACA) was insurance reform and expanding Medicaid eligibility. While studies have shown access disparities in gynecological cancer surgery, limited data exists on access disparities in general gynecology. This study aims to conduct telephone surveys to evaluate (1) appointment success rates and (2) wait time disparities for gynecologic appointments in patients with Medicaid and Commercial insurance.

METHODS:
A prospective cross-sectional study using a telephone survey was conducted in October 2017. The cohort included all ACGME accredited OBGYN residency programs. Earliest appointment times were established for fictional patients with Medicaid then Commercial insurance. The primary outcome was wait time for new patient appointment in days. The secondary outcomes were differences in wait times by states that had more than three OBGYN residency programs and in states that participated in the ACA expansion.

RESULTS:
There were 188 ACGME accredited academic OBGYN residency programs that accepted both Medicaid and Commercial insurance (73.4% participation rate). Of these programs, 48.95% (n= 93) had a longer wait time for new patient visits with Medicaid insurance. Overall, there was significant difference (p< 0.0079) between the mean wait times for new patient visits for patients with Medicaid insurance (30.6 days) versus Commercial insurance (24.6 days).

CONCLUSION:
Our data suggest that Medicaid patients seeking gynecologic care experienced longer wait times and that expansion of ACA was not associated with an improvement in these wait times.
Utilization of Online Family History Collection and Hereditary Cancer Risk Assessment Tool [28M]
Authors: Gabitzsch Emily K. , Susswein Lisa R. , Klein Rachel T. , Metelski Deon , Fagbemi Adebanke F. , Solomon Benjamin D. 
Published: May 2019

INTRODUCTION:
Collection and utilization of family history is necessary for hereditary cancer risk assessment but standardization is difficult in healthcare practices. The web-based, patient-entered MyGeneticsTree (MGT) can be administered outside of medical encounters, targeting follow-up on high-risk patients.

METHODS:
MGT was used in women's health offices between October 2015 and July 2018. Patients (users) were invited by providers directly, or found MGT through other means. MGT was accessed on personal computers, mobile devices, or in-office tablets.

RESULTS:
A total of 1,922 patients completed MGT; the overall completion rate was 85%. The average age was 45 (between 18 and 86) and 93% were female. The majority (87%) of patients were unaffected themselves, but reported a family history of cancer and/or genetic testing. Half (49%) of all patients met clinical guidelines for genetic testing in one of 5 hereditary cancer syndromes. Cancer family history was reported more in maternal (41%) than paternal (29%) relatives, and in first-degree compared to second- or third-degree relatives (85% to 13% or 2%, respectively). Excluding those with a known familial variant, 19.5% (375/1922) pursued multigene hereditary genetic testing, of whom 9% (n=34) were positive for a pathogenic variant.

CONCLUSION:
These results point to successful adoption of an online, patient-driven hereditary cancer risk assessment identifying patients appropriate for genetic testing. When administered to a patient population outside or within the office, MyGeneticsTree identified unaffected individuals with significant cancer family history. Planned enhancements include continued algorithm updates, optimized patient ease of use, and improved testing uptake for at-risk patients.
A Novel Counseling Tool: AMH as a Predictor of Oocyte Yield and Live Birth Rate (LBR) With Oocyte Cryopreservation (OC) [29M]
Authors: Maslow Bat-Sheva L. , Ramirez Leslie B. , Klein Joshua U. 
Published: May 2019

INTRODUCTION:
Methods for counseling women regarding candidacy for OC are limited. This study aims to provide a novel evidence-based tool to interpret serum AMH as a predictor of oocyte yield and LBR in non-infertile women considering OC.

METHODS:
All OC cycles performed at Extend Fertility Medical Practice from 4/2016 through 8/2018 were included. The study was granted IRB exempt status. AMH levels were performed at an independent laboratory using Gen-II ELISA platform. Using published data, the number of oocytes needed for a 50% LBR were calculated per age group. ROC curves for each age group were used to select appropriate cutoffs based on accuracy and simplicity. Associations were made using X2.

RESULTS:
1385 cycles were included. Mean age at cycle start was 36.1+/-3.2. Median AMH 1.83 ng/mL [IQR 1.11-3.12]. Predicted 50% LBR was equivalent to 7 cryopreserved MII oocytes at age ≤34, 9 at 35-37, 11 at 38-40, 20 at ≥-41. ROC curve demonstrated good fit for AMH as a predictor of 50% LBR at each age group (AUC 0.80-0.86, P<.001-.016). Suggested AMH to achieve a predicted 50%LBR with 1 cycle of OC are as follows: ≤34=1.25 (P<.001, OR 4.54 CI 2.61-7.899)35-37=1.50 (P<.001, OR 5.23 CI 3.67-7.44)38-40=1.75 (P<.001 OR 7.97 CI 4.4-14.38)≥41=2.25 (P=.002 OR 1.01-1.60)

CONCLUSION:
Appropriate estimates of per cycle oocyte yield and predicted live birth rates based on age at cryopreservation are critical for enabling women to make informed decisions about their reproductive goals. These data provide a novel method with which to counsel women about their candidacy for OC.
Elagolix Improves Quality of Life Among Uterine Fibroids Patients With Heavy Menstrual Bleeding in Phase III Trials [31M]
Authors: Al-Hendy Ayman , Soliman Ahmed M. , Wang Hui , Coyne Karin , Carr Bruce R. 
Published: May 2019

INTRODUCTION:
Uterine Fibroids (UF) are associated with impaired health-related quality of life (HRQL). The impact of elagolix, an oral gonadotrophin-releasing hormone antagonist, on the HRQL of women with heavy menstrual bleeding (HMB) associated with UF was evaluated.

METHODS:
Premenopausal women aged 18 to 51 with HMB (>80 mL/cycle menstrual blood loss) associated with UF were enrolled in two replicate 6-months phase III placebo-controlled randomized clinical trials (Elaris UF-1, Elaris UF-2). Women were randomized in 1:1:2 fashion to placebo, elagolix 300mg twice daily (BID) and elagolix 300mg BID in combination with 1mg estradiol (E2)/0.5 mg norethindrone acetate (NETA) once-daily add-back therapy (BID+E2/NETA). HRQL was measured using Uterine Fibroids Symptoms Severity and Health-Related Quality of life questionnaire (UFS-QOL) at baseline, months 3 and 6 of treatment. Changes from baseline in Symptom Severity (lower scores indicate lesser symptoms) and HRQL total scores (higher scores indicate better HRQL) were compared between elagolix arms and placebo using ANCOVA models controlling for baseline scores.

RESULTS:
In Elaris UF-1, 102, 104, 207 patients were randomized to placebo, elagolix BID and elagolix BID+E2/NETA, respectively. At month 6, mean reduction in Symptom Severity scores was significantly larger for elagolix BID and elagolix BID+E2/NETA compared to placebo (-48.3, -33.2, -10.3; respectively p<0.001). Mean increase in HRQL total score was significantly higher for elagolix BID and elagolix BID+E2/NETA compared to placebo (47.5, 38.0, 10.9; respectively p<0.001). Similar results were observed in Elaris UF-2.

CONCLUSION:
Elagolix + E2/NETA add-back reduces UF symptoms severity and improves HRQL among women with HMB associated with UF.
How Are We Doing? Documentation of Preconception and Contraceptive Counseling and LARC Use in Type I Diabetic Women [2N]
Authors: Disney Elizabeth , Gawron Lori , Sanders Jessica , Kaur Simranvir 
Published: May 2019

INTRODUCTION:
To explore the frequency of preconception and contraceptive counseling and LARC use in type I diabetic women.

METHODS:
This retrospective cohort study identified women (16-49 years-old) with an ICD-9/ICD-10 code for type I diabetes and documented A1C level in a tertiary referral center between 1/1/2010-10/30/2017. We abstracted preconception or contraceptive counseling and LARC documentation within 1 year pre- and post-highest A1C. We identified provider type: primary care (PCP), endocrinology, obstetrics/gynecology (OB/GYN), and maternal fetal medicine (MFM). We defined advanced disease by micro- or macro-vascular complications or disease >20 years. Multivariable logistic regression related disease severity and provider type to counseling and LARC documentation when controlling for age and race.

RESULTS:
We included 541 women. Median age was 30.7 (range 17-49), A1C was 9.1% (5%-20%), and median 4 visits (range 1-38) during the two-year span. Only 5% received preconception counseling, 25% received contraceptive counseling, and 13% used LARC. MFMs most frequently documented preconception counseling (16%, P=0.01), while OB/GYNs most frequently documented contraceptive counseling (73%, P<0.01). LARC documentation was higher in MFM (26%) and OB/GYN (27%) visits compared to endocrinology (10%) and PCP (11%) visits (all P<0.01). Advanced disease resulted in less preconception counseling (3%, P=0.05), yet similar contraceptive counseling frequency and LARC use compared to non-advanced disease. Contraceptive counseling was highly associated with LARC use (aOR 9.87, 95% CI 5.09-19.12).

CONCLUSION:
Reproductive age type I diabetic women have high healthcare utilization, yet documentation of preconception and contraceptive counseling is sparse. Educating non-OB/GYN providers could avoid missed opportunities to improve pregnancy planning and outcomes.
Impact of Ryan Residency Training on Number of LARCs Inserted during Ob/Gyn Residency Training [5N]
Authors: Vetrici Mariana , Maples Jill , Evans Megan L. , Espey Eve , Ogburn Tony , Zite Nikki B. 
Published: May 2019

INTRODUCTION:
Long-acting reversible contraception (LARC) is an important component of the contraceptive method mix; education and training in LARC provision is an integral skill for women's health care physicians. Performing IUD and contraceptive implant insertions is an Ob/Gyn residency requirement (Level 3 ACGME Milestone). This study determined the average number of LARC devices inserted by Ob/Gyn residents during their training and investigated the impact of Ryan Residency Training on the number of insertions.

METHODS:
In 2016, an electronic survey was distributed to Ob/Gyn residents just before the CREOG in-training examination; 4,322 respondents in US programs completed the survey and were included in the analysis. Residency program zip codes were reported by 4,203 respondents. Zip codes were used to create a “Ryan Training” (RT) categorical variable (with RT, without RT, can't be determined). Data were analyzed using Chi-square statistics.

RESULTS:
Among 3rd and 4th year residents, 6.9% had inserted <11 IUDs, 21.9% had inserted <11 contraceptive implants, and 28.9% had never inserted an IUD immediately post-partum (IPP) IUD. RT was significantly associated with IUD, implant, and IPP IUD insertions (P<.001). Including respondents from all years of residency, a higher percentage of those without RT inserted <11 IUDs (26.2% vs. 11.5%) and <11 implants (28.8% vs. 18.8%), compared to residents with RT. Additionally, 45.2% of residents without RT had never inserted an IPP IUD, compared to 14.3% with RT.

CONCLUSION:
Ob/Gyn residents who train at programs with RT gain broader experience inserting LARCs than those who train at programs without RT.
Initiating and Monitoring a Postpartum Contraceptive Program [8N]
Authors: Lacy Megan , Monaco Alexandra , Zite Nikki B. 
Published: May 2019

INTRODUCTION:
The University of Tennessee in Knoxville is a pilot site for a statewide initiative to provide immediate postpartum long-acting reversible contraception (IPP LARC) access with a patient-centered focus. The pilot includes tracking prenatal contraceptive counseling (CC), postpartum (PP) contraceptive plan on arrival and discharge, and IPP LARC utilization.

METHODS:
Electronic medical record (EMR) was upgraded in January 2018 to allow for a PP contraception quality improvement project. On admission, data points were collected related to prenatal CC and intended plan for PP contraception. Actual PP contraception obtained was documented upon discharge.

RESULTS:
From January 15 through August 30, 2018, 1,968 women delivered, 936 (47.6%) reported prenatal CC; data were missing for 601 (30.5%). Of women who had prenatal CC, 534 (57.1%) obtained planned PP contraception, 153 (16.3%) changed their plan, and data were missing for 249 (26.6%). Women who reported prenatal CC, obtained intended PP contraception more than those without prenatal CC (57.1% vs 9.0%). A total of 216 women reported IPP LARC as their desired plan, data were missing for 62 (28.7%), and 24 (11.1%) of women faced various barriers obtaining IPP LARC or changed their plan. When IPP LARC was the intended plan, women with prenatal CC had more success obtaining IPP LARC than women without prenatal CC (55.1% vs 5.1%).

CONCLUSION:
Data suggest prenatal CC aids in the success women have in obtaining desired contraception and IPP LARC. EMR changes highlighted the importance of prenatal CC. To improve analysis in the future, documentation within EMR can be addressed.
Domestic Violence in Pregnancy-Related Death: A Novel Use of Coroner and Criminal Data in Clark County, Nevada [9N]
Authors: Paul Anthea , Mahesan Arnold 
Published: May 2019

INTRODUCTION:
Existing studies in the literature analyze self-reported domestic violence in pregnant women which may be underestimated in this vulnerable population. Our study explores novel use of autopsy in combination with criminal data to understand domestic violence trends in unnatural deaths in pregnant women.

METHODS:
Retrospective review of women referred to the Clark County medical examiner from 2000-2015 was conducted. Pregnancy was confirmed by autopsy diagnosis, and criminal records were obtained from the Clark County District Attorney's Office. Statistical analysis was performed using student t-test for continuous variables and chi-square for categorical variables.

RESULTS:
7215 women in total were referred to the Clark County medical examiner. 67 women were found to be pregnant at the time of autopsy. 55% of the women that were pregnant at the time of death were victims of pregnancy-related unnatural death (PRUD). 27% of women who were victims of PRUD filed charges of domestic violence against their partners versus 3% who were victims of natural death (p=0.02). Also, 71% (n=5) of women >30 years were victims of PRUD filed charges of domestic violence compared with 13% of women <30 years (n=3) (p=0.04). The most common manner of death among the PRUD group was suicide in 35% (n=13) and 32% (n=12) had a criminal record.

CONCLUSION:
Domestic violence is significantly more prevalent in PRUD than in those who die of natural death. Further, older victims of PRUD were significantly more likely to file charges for domestic violence. The causes underlying these trends are unclear and deserve further attention and study.
Efficacy and Acceptability of an Intimate Partner Violence Workshop for Third-Year Medical Students [10N]
Authors: Cha Sandolsam , Chia Stephanie , Pollack Staci 
Published: May 2019

INTRODUCTION:
Approximately 1 in 4 women have been physically and/or sexually assaulted by a current or former partner. Despite this prevalence, Only a fifth of medical students report an extensive training in addressing intimate partner violence. The objective of this study was to assess the efficacy of a practical workshop built into the OB/GYN clerkship.

METHODS:
A 1 hour curriculum with a flipped-classroom method was developed, which incorporated role-play, video clips, and the use of safety card handouts. The workshop was incorporated into the didactics schedule during the third year medical student's OB/GYN clerkship. A survey with 5 sections (background, knowledge, opinion, personal experience, and acceptability) was sent to gather feedback.

RESULTS:
51 medical students responded to the survey. 49% of the respondents were female. 78% had a prior lecture in IPV. While 39% stated that they feel fairly well prepared to ask questions regarding IPV, only 19% felt similarly prepared to appropriately respond to positive disclosure. The average score on a 10 true/false knowledge assessment was 8. 7.8% have personally experienced IPV. 76% felt it was important to be trained in addressing IPV, 50% felt there was adequate time to cover important topics, and 60.8% would strongly recommend the curriculum to a colleague. Overall, 90% were satisfied or very satisfied with the curriculum.

CONCLUSION:
A practical workshop during an OB/GYN clerkship increased students' confidence in addressing IPV, and was well-received. A follow-up study is assessing whether this curriculum translates to an increase in the number of patients screened and referred to resources.
Increasing Underrepresented Minority Access to Healthcare Professions through Pipeline Programming [14N]
Authors: Iyamu Georgina , North Ware Jamie L. , Looney Kimberly , Aguinaga Maria del Pilar 
Published: May 2019

INTRODUCTION:
The Robert Wood Johnson Foundation Center for Health Policy (RWJF-CHP) at Meharry Medical College (MMC) partnered with a local high school to create a pipeline program that trains minority students enrolled in the Community Health Academy (CHA). The program provided clinical training to successfully pass the certified clinical medical assistant (CCMA) exam that allows trained professionals to perform clinical duties and assist providers in the healthcare setting. It is expected that these students will enroll in an undergraduate institution affiliated with MMC and ultimately matriculate into one of MMC's Professional Schools.

METHODS:
Twenty-five students were selected from 100 applicants by the CHA committee to participate in the one year pilot study. Students submitted resumes, personal statements, and were interviewed. Parental consents were obtained. The RWJF-CHP implemented clinical and educational training which included Science Symposiums, Clinical Internships, Medical Simulation Training, and Tutoring by Meharry faculty, residents, and students.

RESULTS:
Prior to 2017, 25/25 took the CCMA exam and did not pass it. In 2018, 20/25 passed the exam on their first attempt. The current passage rate for students after implementation of this pilot pipeline program for one year was 80%.

CONCLUSION:
Through this pipeline opportunity, students learned clinical skills and earned a certification necessary to work in the medical field. This project demonstrated that the pipeline model is effective in increasing minorities in the healthcare field. Further implications are to expand the model to include other high schools in the Nashville area.