bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of a Diagnosis of Interstitial Cystitis/Bladder Pain Syndrome: A Qualitative Approach [36D]
Authors: Komatsu Emi J. , Volpe Katherine , Pahwa Avita 
Published: May 2019

INTRODUCTION:
Interstitial cystitis/bladder pain syndrome (IC/BPS) is an underdiagnosed chronic pain syndrome that often causes profound detrimental effects on quality of life. We sought to investigate whether obtaining a diagnosis of IC/BPS makes a significant impact on patients' symptom course and coping.

METHODS:
Participants with self-reported IC/BPS completed publicly available online surveys from October 2017-January 2018. Surveys included demographic information, validated questionnaires and free-text response on the utility of obtaining a diagnosis. Researchers coded and analyzed the comments using Dedoose Version 7.0.23 and Grounded Theory methodology.

RESULTS:
1052 participants completed the survey and 673 answered the free-text response. The median age was 53 (interquartile range [IQR] 41, 64) with an average of 7 years (IQR 3, 14) since IC/BPS diagnosis. Two categories were identified in the participants' responses:1) effects of the diagnosis on daily life and 2) effects of the diagnosis on medical care. Within each category, both positive and negative experiences were noted. Effects on daily life included emotional response to diagnosis (hope vs. desperation) and impacts on everyday activities (social support vs. financial burden of treatment). Effects on medical care included IC/BPS-specific treatment (appropriate referrals vs. no improvement despite different treatments) and changes to provider interactions (validation vs. stigmatization). The majority of participants noted emotional benefit and improved treatment with diagnosis. However, some participants reported detrimental effects.

CONCLUSION:
IC/BPS diagnosis has a significant physical and emotional effect on patients' experiences of their symptoms. Validating patients' experiences may help to minimize possible negative effects of diagnosis.
Differences in Body Composition Between Appropriate for Gestational Age and Large for Gestational Age Term Neonates [6E]
Authors: Weatherborn Megan M. , Stark Sydney , Landau Daphne 
Published: May 2019

INTRODUCTION:
At birth, neonates are classified as small, large, or appropriate for gestational age based on birth weight. However, birth weight does not account for differences in body composition. The goal of this study is to investigate the differences in body composition among appropriate for gestational age (AGA) and large for gestational age (LGA) term neonates.

METHODS:
On admission, all term infants in our nursery undergo assessment of body composition and percent body fat (%BF) by a validated anthropometric model. Neonates were grouped by sex then categorized by completed gestational age. Subjects with incomplete data were excluded. Definitions for AGA and LGA were based upon WHO criteria by sex. Data were examined for equal variance and then analyzed using the appropriate Student t test. Data were expressed as mean ± SD. P<.05 was considered significant.

RESULTS:
Our cohort included 1,175 neonates, 636 male and 539 female. For males, mean birth weight in the AGA group (N=601) was 3.35kg (±0.31), and LGA (N=35) 4.26kg (±0.25). For females, mean birth weight in the AGA group (N=500) was 3.18kg (±0.30), and LGA (N=39) 4.04kg (±0.27). We identified a significant difference in mean %BF between the AGA and LGA neonates, for both males (13.12% vs 18.08%, P<.05) and females (13.02% vs 17.98%, P<.05).

CONCLUSION:
We identified a significant difference in body composition between AGA and LGA term neonates, with higher %BF in the LGA group. Evaluating patterns of neonatal fat mass at birth may be useful in understanding patterns of excessive fetal growth and nutrient acquisition in utero.
Differences in Body Composition Between Appropriate Gestational Age and Small Gestational Age Infants at Term [7E]
Authors: Landau Daphne , Stark Sydney , Weatherborn Megan 
Published: May 2019

INTRODUCTION:
Small for Gestational Age (SGA) infants are defined as <10 percentile birthweight. Birthweight centiles provide limited information on neonatal nutritional status. Body composition measures percent body fat (%BF) and may be a useful adjunct to assess undernutrition. We sought to investigate the differences in body composition between Appropriate for Gestational Age (AGA) and SGA infants at term.

METHODS:
On admission, all term infants in our nursery undergo assessment of %BF by a validated Anthropometric Model. For this analysis, infants were grouped by sex then categorized by completed gestational age (GA). Subjects with incomplete data were excluded. Definitions for AGA and SGA were based upon WHO criteria by sex. Data was examined for equal variance and then analyzed using the appropriate Student t test. Data was expressed as mean ± SD. P<.05 was considered significant.

RESULTS:
Our cohort included 1,262 infants, 680 male and 582 female. For males, mean birthweight for AGA infants (N=601) was 3.35 kg (±0.31) and SGA (N=79) 2.53 kg (±0.21). For females, mean birthweight for AGA infants (N=500) was 3.18 kg (±0.30) and SGA (N=82) 2.45 kg (±0.22). There was a significant difference in mean %BF between the AGA and SGA infants for both males (13.12 vs 7.77, P<.05) and females (13.02 vs 8.25, P<.05).

CONCLUSION:
We identified a difference in %BF between AGA and SGA infants for both males and females. Future studies should investigate whether infants with low %BF are at higher risk for adverse perinatal outcomes and if %BF at birth can provide a better estimate of likely neonatal morbidity.
Does Excessive Gestational Weight Gain Increase the Risk of Cesarean Delivery? [13E]
Authors: Wells Matthew , John Nicole , Vahanian Sevan , Kinzler Wendy Lyn , Sicuranza Genevieve B. , Vintzileos Anthony M. 
Published: May 2019

INTRODUCTION:
To determine whether excessive gestational weight gain (GWG), as defined by the Institute of Medicine (IOM) guidelines, increases the risk of cesarean delivery (CD) in term singleton gestations.

METHODS:
This was a retrospective cohort study of singleton gestations at term (>37 weeks gestation), admitted for intended vaginal delivery from January to December 2015. Patients with prior CD, multiple gestation, malpresentation, or missing data were excluded. Demographics, obstetrical and neonatal characteristics, first office visit weight/BMI, and admission weight/BMI were collected from prenatal and hospital records. Women were divided into 2 groups: those with excessive GWG, and those with weight gain at or below IOM guidelines. Baseline characteristics and CD rates were compared between the 2 groups using parametric and non-parametric tests as appropriate with a P<0.05 considered statistically significant and relative risks were calculated.

RESULTS:
A total of 743 women met inclusion criteria with an average pre-pregnancy BMI of 25.5+/-5.6 kg/m2. The CD rate for the cohort was 19.2% (n=143). After adjusting for age, pre-pregnancy BMI, parity, and race, women with excessive GWG were 50% more likely to have a CD compared to those with lower GWG [relative risk 1.51 (1.07-2.05)]. This increased risk was greatest in nulliparous women. A trend toward increased rate of labor dystocia as an indication for CD was noted in the excessive GWG group.

CONCLUSION:
Women who gain more than recommended weight by the IOM guidelines, particularly if nulliparous, are at increased risk of having a CD compared to those who have appropriate weight gain.
Does Fetal Testing Decrease Fetal Demise in Pregnancies Complicated by Obesity? [14E]
Authors: Valle Eduardo , Kirsten Herr , Vragovic Olivera , Abbott Jodi , Markenson Glenn R. 
Published: May 2019

INTRODUCTION:
Maternal obesity complicates over 30% of pregnancies, and is a risk factor for fetal demise (FD). Some have advocated increased fetal surveillance in pregnancies complicated by maternal obesity. The objective of this study is to determine if a protocol for fetal testing in obese women decreases the risk of FD.

METHODS:
This was a retrospective cohort study of women who delivered at Boston Medical Center, from 2006-2018, and deemed exempt by th IRB. FD rates in obese women (BMI≥30) with no other pregnancy complications, were compared to low risk pregnancies. Obese patients were scheduled for growth ultrasounds every 4 weeks and weekly fetal testing starting at 36 weeks.

RESULTS:
There were 3,037 women in the obese group, and 13,980 women in the uncomplicated group. There was no significant difference in FD between the two groups. The obese group had a fetal death rate of 3/1000 (n=10) after 24 weeks gestation, and 1/1000 after 36 weeks gestation (n=2) compared to a FD rate in the normal group of 5/1000 (n=66) after 24 weeks gestation and 2/1000 (n=31) after 36 weeks gestation. The obese group had an increased median number of fetal tests (4 vs 2, P<0.01), and cesarean deliveries (35% vs 24%, p<0.01).

CONCLUSION:
Despite a known increased incidence of FD in pregnancies complicated by obesity, a protocol of intensive antepartum fetal testing resulted in a FD incidence similar to a low risk population. This suggests that increased fetal testing should be offered for all pregnancies complicated by obesity.
Evaluating Driver's Safety During Pregnancy: A Prospective Observational Study [19E]
Authors: Zaragoza Jorge E. , Franco Andrea , Colina Andreina , Bremer Pamela , Villanueva Mariana , Gei Alfredo F. 
Published: May 2019

INTRODUCTION:
To evaluate seatbelt use, driving positioning and steering wheel clearance to abdomen and chest in pregnant women drivers.

METHODS:
Prospective study including pregnant women attending prenatal care in two private practices serving a multi ethnic population in Houston, TX. Observations of seat belt (SB) use, patient's position and clearance to the steering-wheel (SW) were recorded in the patient's vehicles. All patients were counseled on proper SB placement. Pregnancy outcomes were not obtained. Chi square, Fisher's exact test and ANOVA used as appropriate (significance <.05).

RESULTS:
125 pregnant women were included. The average patient was 31.6+/-5.7 years (mean+/-S/D); gravida 2 (range: 1-6); 25.5 (+/-9.3 weeks) had a BMI of 31.6+/-7.2. 64.8% of patients had a previous MVA. Though 74.4% of women felt comfortable with the SB placement, 47.2% of them had an incorrect placement. A clearance <25 cm between lower SW rim and abdomen was seen in 94.4%. Gestational age (GA) and BMI had an adverse impact in the clearance between the SW and maternal trunk (p<0.001).

CONCLUSION:
A high proportion of driving pregnant women had been previously involved in a MVA. According to NTHSA guidelines a large proportion of driving pregnant women have an inappropriate placement of the SB. The majority of patients have an inadequate distance between the uterus and the steering wheel for safe deployment of an air bag. Gestational age and BMI have a negative impact in the ergonomics of pregnant drivers.
Perceptions and Comfort of Obstetricians and Gynecologists of Cesarean Hysterectomy [20E]
Authors: Menzies Anya V. , Pearl Michael Loran , Gossner Gabrielle , Burke William M. 
Published: May 2019

INTRODUCTION:
Within obstetrics and gynecology, many physicians sub-specialize. As a result, surgical experience differs among providers. On labor and delivery, postpartum hemorrhage is a rare event that occasionally leads to cesarean hysterectomy. If this occurs, some providers may find themselves performing a technically challenging procedure that they perform infrequently.

METHODS:
As part of our departmental QA assessment, a survey was distributed to attending physicians who oversee the care of patients on labor and delivery. The purpose of this survey was to better understand frequency of hysterectomy and comfort with emergent cesarean hysterectomy among these physicians.

RESULTS:
There were 27 (93%) respondents, which included 17 (62.9%) generalists, 7 (25.9%) MFM, and 3 (11.1%) MIS/Urogyn sub-specialists. Regarding total hysterectomies performed per year, 7 (25.93%) surgeons reported completing greater than 15, while the majority, 12 (44.4%), reported completing 1-5 hysterectomies per year by any method. For abdominal hysterectomies, 5 (18.52%) surgeons reported none, 17 (62.97%) surgeons reported 1-5 per year, one reported 11-15, and none reported greater 15. When describing their comfort with performing an emergent cesarean hysterectomy, 23 (85.25%) surgeons reported feeling either very comfortable or moderately comfortable. Of the surgeons who perform five or fewer abdominal hysterectomies per year, 15.8% describe feeling uncomfortable performing an emergent cesarean hysterectomy.

CONCLUSION:
There was no correlation between self-reported number of hysterectomies performed and comfort level of obstetricians and gynecologists managing emergent cesarean hysterectomies. Given recent literature suggesting increased complication rates with low- volume surgeons, a more rigorous approach to credentialing for and completion of cesarean hysterectomy may be appropriate.
Piloting a Breastfeeding-Friendly Provider's Office Protocol at a Private Obstetrical Clinic [24E]
Authors: Haring Anna , Duong Jennifer , Woods Nikki Keene , DeAllie Addia , Grainger David A. , Robbins Ashley 
Published: May 2019

INTRODUCTION:
Extended breastfeeding rates among all demographics remain lower than national recommendations. The overall objective of this study was to pilot a “Breastfeeding-Friendly Provider's Office Protocol” at a private obstetrical clinic, and to examine breastfeeding outcomes.

METHODS:
Components of the Academy of Breastfeeding Medicine (ABM) Breastfeeding-Friendly Provider's Office Protocol were implemented at a single clinic, which included: adopting a breastfeeding-friendly office policy, displaying positive images of breastfeeding and signs of support, standardizing breastfeeding education, and providing a breast pump prescription. Breastfeeding rates prior to and after protocol implementation were assessed via hospital data. Patients were invited to complete electronic surveys regarding breastfeeding support after attending the six week postpartum visit. IRB committee approval was obtained for this study.

RESULTS:
Maternal preference for exclusive breastfeeding increased from 71.9% to 86% (N=128). Breastfeeding at hospital discharge increased from 74.7% to 84.8%, and at the six week postpartum visit increased from 88.2% to 100%. During the intervention, most patients received education packets (82.8%, 106/128) and breastfeeding pump prescriptions (84.4%, 107/128). Sixty-four patients completed the survey, of which 34% (22/64) were first-time mothers, and average infant age was 9.6 weeks. Breastfeeding initiation was self-reported at 98% (63/64). At the time of postpartum survey, 90% (56/58) reported continued breastfeeding. Five patients (7.8%) reported the need for more breastfeeding information.

CONCLUSION:
Implementing a Breastfeeding-Friendly Provider's Office Protocol at a private obstetrical clinic improved maternal preference for exclusive breastfeeding, breastfeeding at hospital discharge and six weeks postpartum. There continues to be a desire for more breastfeeding information during the postpartum period.
A Team-Based Approach for Improving Postpartum Glucose Screening in Gestational Diabetes Patients [28E]
Authors: Bounds Faye L. , Giwa Erica P. , Armstrong Faunda N. , Miao Di , Hollier Lisa M. , Ratan Bani 
Published: May 2019

INTRODUCTION:
Postpartum testing of gestational diabetes (GDM) patients with an oral 2-hour glucose tolerance test (OGTT) is suboptimal, with national rates ranging from 18-57%. The purpose of this study was to investigate if a standardized workflow supplemented with educational sessions could improve the OGTT screening rate.

METHODS:
A multi-disciplinary workflow was implemented in two Medicaid clinics in January 2018. Pre-intervention subjects were GDM patients in the 4-12 week postpartum period between March-June 2017, while post-intervention subjects were between January-April 2018. Immediately prior and during the post-intervention time period, the obstetrical team received small-group education sessions on the American College of Obstetricians and Gynecologists (ACOG) GDM guidelines, with re-enforcement of workflow. A pretest and posttest were performed to assess effectiveness. Paired t-test was used to compare the pretest and posttest scores, and chi-square testing was used to compare compliance with screening. IRB approval was obtained for this study.

RESULTS:
Nineteen out of thirty members (63%) of the obstetric team completed the educational session. Mean pretest score for the team was 57.4%; the mean posttest score was 99.2% (p<0.01). Eighteen patients were in the pre-intervention group, while 26 patients were in the post-intervention group. Postpartum screening of GDM patients improved from 39% to 77% after workflow implementation (p=0.01).

CONCLUSION:
Educational sessions and standardized workflow interventions utilizing a multi-disciplinary team were associated with improvement in both understanding of the ACOG guidelines and patient compliance with postpartum glucose screening. This team-based approach may be useful in other quality improvement initiatives.
Music and Its Impact on Pain and Anxiety During Office Hysteroscopy: A Randomized Controlled Trial [31E]
Authors: Yuan Valerie 
Published: May 2019

INTRODUCTION:
Office hysteroscopy is an important diagnostic and therapeutic procedure for many intrauterine diseases. Excessive pain is a limiting factor in patient compliance and is associated with reduced levels of satisfaction. We investigate the impact of music on patients' pain and anxiety levels during office hysteroscopy.

METHODS:
From March to September 2017, patients undergoing diagnostic office hysteroscopy at Harbor-UCLA Medical Center were computer-generated, block randomized into two groups: Music group (Toradol 30 mg intra-muscular and patient's choice of background music) and Non-Music Group (Toradol 30mg intra-muscular only). IRB approval was obtained. Hysteroscopy was performed by rotating residents supervised by the same attending physician. Using Visual Analog Scales and abbreviated State-Trait Anxiety Inventory questionnaires, we assessed pain and anxiety levels before and after hysteroscopy.

RESULTS:
Of 72 eligible patients, 58 patients were included in the final analysis: 28 Music Group (MG) patients and 30 Non-Music Group (NMG) patients. MG patients had a significant greater anxiety level decrease compared to NMG patients (-9.66 vs -2.94, P=.01). Although not reaching statistical significance, MG patients had trends toward greater decrease in heart rate (-4.95 vs -2.52), less increase in systolic blood pressure (2.73 vs 5.12), and smaller pain score change (19.08 vs 24.29) compared to NMG patients. 27 of 28 MG patients enjoyed the music played during the procedure.

CONCLUSION:
We show that music can be used as an inexpensive and feasible adjunct to pain medications to decrease a patient's perception of anxiety during office hysteroscopy. Future studies can investigate the potential benefits of music during other gynecological procedures.
Patient Preferences for Obstetrician and Gynecologists on the US-Mexico Border [32E]
Authors: Domina Michael Glenn. , Sanchez Sheralyn , Mallawaarachchi Indika , Mendez Melissa Dawn 
Published: May 2019

INTRODUCTION:
The field of OBGYN is predominantly made up of female physicians. Physician communication, patient perception, and intimate examinations may influence a patient's preference for female providers. No studies on physician preference have been performed along the United States-Mexico border. We performed a cross-sectional study to evaluate which factors play the greatest role in shaping a patient's OBGYN preference.

METHODS:
Patients presenting for their first OB or GYN care visit, age 18 years or older, completed an anonymous self-administered survey. Odds ratios (OR) for dichotomous outcomes were calculated using logistic regression.

RESULTS:
Of 233 patients, 48.9% preferred having a female OB/GYN physician while 40.2% preferred female physicians when receiving prenatal care. Women who were born in Mexico were significantly less likely than women born elsewhere to have a gender preference when choosing an OB/GYN: adjusted OR=0.45, 95% confidence interval (CI): 0.24-0.85, P=0.013. Subjects who replied that the personality of the doctor is an important quality when choosing an OB/GYN were less likely to have a gender preference when choosing an OB/GYN. Respondents whose annual household income was $40,000 or greater were more than twice as likely as those with an income of <$40,000 to answer “male” or “female” versus “no preference” when asked which gender of doctors have more sympathy: adjusted OR=2.60, 95% CI: 1.08-6.25, P=0.032).

CONCLUSION:
Women who were born in Mexico and those who considered the provider's personality when selecting an OB/GYN were less likely to have a gender preference when choosing an OB/GYN.
Characteristics of Ovarian Cancer Patients on Neoadjuvant Chemotherapy Unable to Have Debulking After 3 Cycles [35E]
Authors: Dunn Timothy , Norton Sara E. , Smith Haller J. , Leath Charles Alexander 
Published: May 2019

INTRODUCTION:
To report on characteristics of patients undergoing neoadjuvant chemotherapy (NACT) for advanced ovarian, fallopian tube, or primary peritoneal carcinoma who did not undergo interval debulking-surgery after three cycles.

METHODS:
An IRB retrospective cohort study was performed on women undergoing NACT following diagnosis. Abstracted data included demographics, clinicopathologic features, treatment and toxicities.

RESULTS:
Of 96 identified patients, 30 (31.3%) patients did not undergo surgery after 3 cycles of NACT. Median age was 66.5 (range: 46-85) with median BMI 30.0 (21.2-47.8). Median Charlson Comorbidity Index was 6 (2-11). Median CA-125 was 1240.4 (23.6-11,820). Median baseline albumin was 2 (1.9-4.1). Average neutrophil to lymphocyte ratio was 5.80 (0.9-21.5). Adenocarcinoma was the most common histology (83.3%). 70% of cases were diagnosed with laparoscopy and 20% by cytology. 20% of patients required treatment delays and 33% of patients required hospitalization during treatment. 55% of cases specified residual disease or CA125 elevation for continued treatment as opposed to debulking after 3 cycles. 10.3% of patients required continued therapy due to regimen changes during treatment.

CONCLUSION:
Patients receiving NACT who did not undergo debulking had a median albumin of <3 along with a significant median comorbidity index. Patients who did not undergo surgery after 3 cycles had significant rates of treatment delay and hospitalization during their treatment course, and the most common cited reason for continued therapy was persistent disease or persistent CA125 elevations.