bluuebunny/crossref_metadata_2025_split huggingface dataset:
Career Expectations of Obstetrics and Gynecology Residents and Future Residents
Authors: Alston Meredith J. , Ehrig Jessica , Autry Amy (Meg) , Wagner Sarah A. , Kohl-Thomas Belinda M. , Allshouse Amanda A. , Gottesfeld Marshall , Stephenson-Famy Alyssa 
Published: September 2018

OBJECTIVE:
To understand contemporary fourth-year medical student and resident career expectations in obstetrics and gynecology.

METHODS:
Students invited for obstetrics and gynecology residency interviews and residents (postgraduate years 1–4) at the University of Colorado, University of Washington, University of California San Francisco, Loyola University, St. Joseph's Hospital, and Texas A&M in 2016–2017 received a voluntary, electronic survey regarding career expectations. Questions were compared between students and residents using a χ2 test for category responses and for age a two-sample t test.

RESULTS:
Response rates were similar between students (68% [277/409]) and residents (63% [97/153]). Residents compared with students were more frequently planning to enter private practice (43% vs 19%) and less frequently planning an academic career (19.4% vs 30.4%) or subspecialties (38% vs 51%) (P<.001). Although most respondents planned to work full-time (96% vs 94.9%), 83% (vs 94%) of residents planned to work greater than 40 hours per week (P<.001). Respondents reported greater than $150,000 in educational debt (65%) and anticipated starting salary greater than $200,000 (89%). More residents planned to retire by age 60 years (23% vs 7%) (P<.001). Thirty-eight percent of residents reported having changed career plans during residency, citing work–life balance as the most important factor (89%).

DISCUSSION:
Trainees' career expectations appear to evolve over time moving toward a higher likelihood to pursue private practice, work fewer hours, and retire earlier despite large educational debt. It is critical that the specialty understand these trends when planning to address national workforce needs.
Delayed Childbearing as a Growing, Previously Unrecognized Contributor to the National Plural Birth Excess
Authors: Adashi Eli Y. , Gutman Roee 
Published: September 2018

OBJECTIVE:
To establish the annual and cumulative multiyear contribution of delayed childbearing to the national plural birth excess.

METHODS:
Using publicly available national birth data reported by the National Center for Health Statistics, we estimated the contribution of delayed childbearing to the national plural birth excess through 2016. To this end, the observed as well as the maternal age- and race-adjusted national plural birth rates were assessed before (1949–1966; n=71,570,717) and during (1971–2016; n=166,817,655) the assisted reproduction era. Comparable estimates through 2025 relied on simulated projections.

RESULTS:
The relative risk estimates of unassisted plural births by maternal age before the assisted reproduction era (1949–1966) proved unimodal and race-dependent. The risk of unassisted plural births in 35- to 39-year-old black women proved 2.75-fold higher than that of 15- to 19-year-old counterparts (39.81/1,000 to 14.48/1,000; 95% CI 2.67–2.83). A 2.47-fold risk increment was noted for comparably aged white women (28.76/1,000 to 11.63/1,000; 95% CI 2.43–2.52). Similar age-dependent risk increments were obtained for twin and higher order births. An increasingly prominent delayed childbearing trend during the assisted reproduction era (1971–2016) gave rise to 255,964 (95% CI 134,746–375,581) and 66,271 (95% CI 34,099–96,197) unassisted plural births by white and black women, respectively. In 2016 alone, delayed childbearing accounted for 24% (95% CI 15–32%) and 38% (95% CI 28–47%) of the national plural birth excess for white and black women, respectively. By 2025, delayed childbearing could account for as much as 46% (95% CI 32–60%) and 40% (95% CI 30–53%) of the national plural birth excess for white and black women, respectively.

CONCLUSION:
Delayed childbearing, a growing contributor to the national plural birth excess previously solely ascribed to assisted reproduction, warrants greater consideration in future clinical, analytic, and policy deliberations as well as in individual family planning decisions.
Team-Based Learning Sessions Compared With Traditional Lecture in the Obstetrics and Gynecology Clerkship
Authors: Krase Kelli , Pfeifer Emily , Swan Kimberly 
Published: September 2018

OBJECTIVE:
To estimate the effects of team-based learning sessions as part of the curriculum for the obstetrics and gynecology clerkship.

METHODS:
This is a prospective cohort study of clinical clerkship curriculum undertaken in Kansas City and Wichita between 2013 and 2017. A team-based learning curriculum included the same topics as the traditional lecture-format lectures and was instituted in Kansas City. The primary outcome was the obstetrics and gynecology National Board of Medical Examiners examination given at the end of the clerkship, both before and after the implementation of the team-based learning curriculum in Kansas City. An online questionnaire issued by the University of Kansas School of Medicine assessed learner satisfaction. A voluntary multiple-choice examination taken by both Kansas City and Wichita students months after clerkship completion assessed knowledge retention.

RESULTS:
The post–team-based learning Kansas City cohort scored a mean of 78.6 (95% CI 77.8–79.4) on the National Board of Medical Examiners obstetrics and gynecology subject examination compared with the pre–team-based learning Kansas City cohort scoring a mean of 74.6 (95% CI 73.6–75.6, P<.001). Student surveys did not show significant differences in satisfaction between pre–team- and post–team-based learning cohorts in Kansas City. There was no significant difference in knowledge retention scores between Kansas City and Wichita cohorts.

DISCUSSION:
We found significant improvement in National Board of Medical Examiners subject examination scores, which is likely the result of multiple curriculum changes, including the shift from didactic sessions to the active learning strategy of team-based learning. Team-based learning has provided a beneficial and stimulating learning experience for students.
An Interactive Holographic Curriculum for Urogynecologic Surgery
Authors: Siff Lauren N. , Mehta Neil 
Published: September 2018

BACKGROUND:
Urogynecologic surgery, transvaginal pelvic floor surgery in particular, requires learning by feel and high-volume pattern recognition. In the era of limited duty hours and case numbers, we sought to develop a curriculum, one that can be self-guided, to help trainees develop a spatial understanding of the relationships of pelvic floor musculature, ligamentous supports, and surrounding neurovasculature outside of the operating room.

INSTRUMENT:
We created and piloted an innovative interactive holographic using an augmented reality headset to teach surgical anatomy, procedural steps, recognition, and management of the uterosacral ligament suspension and sacrospinous ligament fixation, the two most common native tissue vaginal prolapse repairs.

EXPERIENCE:
Our curriculum was independently trialed by obstetrics and gynecology residents and subspecialty fellows and was widely accepted by trainees, postgraduate levels 1–6. As compared with usual self-study, 88% ranked the modules as “much” or “very much better” and 81% would be “likely” or “very likely” to use mixed reality smartglasses to prepare for surgery.

CONCLUSION:
This interactive holographic curriculum is a novel technique to teach complex pelvic floor anatomy, key steps, and management of complications of the uterosacral ligament suspension and sacrospinous ligament fixation. It is widely accepted by obstetrics and gynecology residents and gynecologic subspecialty fellows.
Prenatal Treatment and Outcomes of Women With Opioid Use Disorder
Authors: Brogly Susan B. , Saia Kelley E. , Werler Martha M. , Regan Emily , Hernández-Díaz Sonia 
Published: September 2018

OBJECTIVE:
To describe the characteristics, treatment, and outcomes of pregnant women with opioid use disorder.

METHODS:
Women attending an obstetric and addiction recovery clinic in Boston from 2015 to 2016 were enrolled in a prospective cohort study and followed through delivery (N=113). Buprenorphine or methadone was initiated clinically. The Addiction Severity Index was administered at enrollment. Prenatal and delivery data were systematically abstracted from medical charts.

RESULTS:
Most women in the cohort were non-Hispanic white (80.5%) with a mean age of 28 years. Few women were married (8.9%). More than half of the cohort had been incarcerated, 29.2% had current legal involvement, and 15.0% generally had unstable housing. A majority (70.8%) were infected with hepatitis C and histories of sexual (56.6%) and physical (65.5%) abuse were prevalent. Regular substance used included heroin (92.0%), injection heroin (83.2%), other opioids (69.0%), marijuana (73.5%), alcohol (56.6%), and cocaine (62.8%). Fifty-nine women (52.2%) were treated initially with prenatal buprenorphine and 54 (47.8%) with methadone; 49.6% also were taking concomitant psychotropic medications. Employment (0.766±0.289) and psychologic (0.375±0.187) Addiction Severity Index scores were the highest, indicating the most severe problems in these areas. Opioid use relapse did not differ by treatment (44.7% overall). Thirteen (22.5%) of 59 women treated with buprenorphine transitioned to methadone mainly because of positive opioid screens. Overall, 23.0% (n=26) of the cohort discontinued clinical care. The number of pregnancy losses was small (three therapeutic abortions, four miscarriages, one stillbirth), with an overall live birth rate of 90.8% (95% CI 82.7–95.9).

CONCLUSION:
These data on the social circumstances, substance use, treatment, and treatment outcomes of pregnant women with opioid use disorder may help clinicians to understand and treat this clinically complex population.
Recent progress in systemic sclerosis-interstitial lung disease
Authors: Castelino Flavia V. , Dellaripa Paul F. 
Published: September 2018

Purpose of review
Systemic sclerosis is a systemic autoimmune disorder wherein interstitial lung disease (ILD) is the major source or morbidity and mortality. Research into mechanisms of fibrosis and its intersection with autoimmunity, specifically lung fibrosis, has accelerated and been applied to autoimmune disorders such as scleroderma. This review highlights important emerging insights and treatment trials.

Recent findings
The important elements of this review focus on the challenges faced in identifying patients not only who develop lung disease but who are at a higher risk for progression given the heterogeneous natural history of ILD in scleroderma. Risk assessment scoring models using radiographic and physiologic parameters are highlighted and recent and ongoing clinical trials in scleroderma ILD are discussed.

Summary
The implications of much of this ongoing work is a potential paradigm shift in our ability to identify those patients at risk for progression, and to offer novel therapies that can limit the progression of inflammatory and fibrotic lung disease in this challenging group of patients.
Gastrointestinal involvement in systemic sclerosis: diagnosis and management
Authors: McMahan Zsuzsanna H. , Hummers Laura K. 
Published: September 2018

Purpose of review
This review provides important updates in systemic sclerosis (SSc)-related gastrointestinal disease, with a particular focus on the diagnosis and management of dysmotility.

Recent findings
In the past 2 years, several studies were published that present interesting diagnostic insights into SSc and gastrointestinal dysmotility. Studies focusing on new therapies and the novel application of existing therapies, both in SSc and non-SSc-associated gastrointestinal dysmotility syndromes, demonstrate progress in the management of these challenging complications.

Summary
SSc gastrointestinal disease is heterogeneous in its clinical presentation, which presents a challenge in diagnosis and management. Objective studies may help to identify patterns of gastrointestinal dysmotility and more specifically target therapy. A variety of drugs are now available or are under study in the management of gastrointestinal dysmotility, such as prucalopride, intravenous immunoglobulin, pyridostigmine, linaclotide, relamorelin, and others. These drugs may improve symptoms and quality of life in SSc gastrointestinal patients. Combination therapies are also under study. Electroacupuncture, dietary intervention (e.g. medical nutrition therapy, low FODmap diet), and medical cannibus may also play a role in alleviating patient symptoms; however, more data are needed to define the role of these interventions in SSc.
Peculiar clinicopathological features of immune-mediated necrotizing myopathies
Authors: Allenbach Yves , Benveniste Olivier 
Published: September 2018

Purpose of reviewIn the past decade, immune-mediated necrotizing myopathies have emerged as a separate entity in the heterogenous group of autoimmune myopathies. This group is characterized by clinical manifestations restricted to the muscle tissue, and until recently, the definition was based on muscular pathological features.Recent findingsIt was shown that they are the most severe autoimmune myopathies in term of muscle damages. They have been associated with two myositis-specific antibodies: either anti-signal recognition particle (anti-SRP) or anti-hydroxy-3-methylglutaryl-CoA reductase (anti-HMGCR) antibodies. These two antibodies are now considered as immune-mediated necrotizing myopathy (IMNM) diagnostic criteria. Each antibody delineates a homogenous subgroup of IMNM patients in terms of severity and IMNM without myositis-specific antibodies have a high risk of malignancy. In addition, pathological observations as well as in-vitro experiments suggest the pathogenic role of anti-SRP and anti-HMGCR antibodies.SummaryIMNM are muscle-specific autoimmune diseases associated with a severe weakness and a risk poor muscle strength recovery. Anti-SRP and anti-HMGCR antibodies are specifically associated with this condition and are crucial for the diagnosis and the prognosis. The muscle biopsy remains necessary for IMNM diagnosis in absence of myositis-specific antibodies.
Pedicled Vascularized Bone Graft of the Distal Radius for Recalcitrant Nonunion of the Distal Humerus
Authors: Zaidenberg Ezequiel E. , Juarez Cesca Fernando , Pastrana Martin J. , Zaidenberg Carlos R. 
Published: September 2018

Objectives:
To analyze the clinical and radiological outcomes of a series of patients treated with a pedicled vascularized bone graft (VBG) of the distal radius for the treatment of recalcitrant atrophic nonunions of the distal humerus.

Design:
Retrospective clinical study.

Setting:
University-affiliated teaching hospital.

Patients:
Fifteen patients with supracondylar humeral atrophic nonunions with at least 3 previous failed surgical interventions were included.

Intervention:
Debridement of the distal humerus nonunion through a posterior elbow approach with provisional fixation was performed. Then, a pedicled VBG was harvested from the distal radius and tunneled back into the humeral bone defect. Iliac crest was used as needed, both for the nonunion and to stabilize the radius. Finally, definitive fixation with 2 locked plates was performed.

Main Outcome Measurements:
Radiological results, complications, elbow range of motion, Mayo elbow performance score, and subjective pain were evaluated.

Results:
There were 4 male and 11 female patients, with a mean age of 51 (range, 28–73) years. The mean follow-up period was 46 (range, 37–72) months with a minimum of 3 years. Radiological consolidation was achieved in all patients. Elbow range of motion was >100 degrees in 11 patients and between 50 and 100 degrees in 4 patients. Preoperative Mayo scores were poor in all patients. At final follow-up, Mayo scores were excellent in 3, good in 9, and fair in 3 patients. The mean postoperative visual analog scale score was 1.2 (range 0–3).

Conclusions:
Pedicled VBG of the distal radius was shown to be a reliable and effective alternative for the treatment of recalcitrant atrophic nonunions of the distal humerus, when other methods have failed.

Level of Evidence:
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Osteonecrosis After Surgically Repaired Proximal Humerus Fractures Is a Predictor of Poor Outcomes
Authors: Belayneh Rebekah , Lott Ariana , Haglin Jack , Konda Sanjit , Zuckerman Joseph D. , Egol Kenneth A. 
Published: September 2018

Objectives:
To determine the effect of osteonecrosis (ON) on the clinical and functional outcome after open reduction and internal fixation of proximal humerus fractures.

Design:
Prospective cohort study.

Setting:
Academic medical center.

Patients:
Over a 12-year period, patients were screened and identified on presentation to the emergency department or in the clinical office for inclusion in an institutional review board–approved registry. One hundred sixty-five patients with 166 proximal humerus fractures met inclusion criteria. Eight patients developed radiographic evidence of ON (4.8%).

Intervention:
Surgical repair of proximal humerus fractures.

Main Outcome Measure:
Patients were divided into 2 cohorts; 1 cohort being those diagnosed with ON and the other cohort being those who were not. All patients were prospectively followed and assessed for clinical and functional outcomes at the latest follow-up visit (mean = 22.9 months) using the Disabilities of Arm, Shoulder and Hand survey along with ranges of motion of the injured extremity.

Results:
Average postoperative forward elevation for patients with ON was worse than those without ON (P = 0.002). Additionally, there was a significant difference in Disabilities of Arm, Shoulder and Hand scores at the latest follow-up between the 2 groups (P = 0.026). There was no difference in external rotation or mean length of follow-up between the 2 groups (P > 0.05).

Conclusions:
This study demonstrates the negative effects of ON after open reduction and internal fixation of proximal humerus fractures. Those who develop ON have poorer functional and clinical outcomes as compared with patients without ON. Consequently, the development of ON can be used as a predictor of poor outcomes.

Level of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Biomechanical Evaluation of Osteoporotic Proximal Periprosthetic Femur Fractures With Proximal Bicortical Fixation and Allograft Struts
Authors: O'Connell Robert S. , Owen John R. , Hansen Erik J. , Bashir Azhar S. , Wayne Jennifer S. , Satpathy Jibanananda , Kates Stephen L. 
Published: September 2018

Objectives:
To evaluate the strength of proximal bicortical fixation using a novel osteoporotic synthetic bone model of Vancouver B1 periprosthetic proximal periprosthetic femur fractures (PFFs) and to assess the influence of strut allograft augmentation with regard to allowing early assisted weight bearing. The secondary aim was to evaluate whether the strut position, either medial or anterior, influenced the strength of the construct.

Methods:
Thirty synthetic osteoporotic femurs were implanted with cemented stems. A segmental defect made distal to the stem simulated a fracture and was repaired with a stainless steel locking compression plate and 2 stainless steel proximal locking attachment plates. Specimens were then divided into 3 groups: no-strut, medial strut, and anterior strut. Cadaveric femoral struts were wired to the specimens. Cyclic axial compression simulated assisted weight bearing and was followed by loading to failure.

Results:
Medial struts required higher failure load than no-strut (P = 0.008) and more energy to failure than anterior (P = 0.018) or no-strut (P < 0.001). The higher load to failure, however, would not be advantageous in clinical practice because estimates for assisted weight bearing after fractures in average-weight patients are well below these failure loads. Furthermore, all specimens tolerated cyclical loading. All failures occurred distal to the plate originating at the last screw hole.

Conclusions:
Failure loads for all groups were above what would be expected for low-demand activities of assisted weight bearing. Therefore, proximal bicortical fixation should allow for early, assisted weight bearing without allograft strut augmentation even with lower density bone.
Developing Research to Change Policy: Design of a Multicenter Cost-Effectiveness Analysis Comparing Intramedullary Nailing to Skeletal Traction in Malawi
Authors: Lau Brian C. , Wu Hao-Hua , Mustafa Mohammed , Ibrahim John , Conway Devin , Agarwal-Harding Kiran , Shearer David W. , Chokotho Linda 
Published: September 2018

Introduction:
The purpose of our study is to prospectively evaluate the cost effectiveness of intramedullary nailing compared with skeletal traction in a resource-limited setting where traction remains the most common definitive treatment.

Methods:
This multicenter, prospective multicenter investigation was conducted in Malawi at 2 central hospitals and 3 district hospitals. The project was divided into phases. In phase 1, the EuroQol-5D and SMFA were translated and validated in Chichewa. In phase 2, adult patents with OTA/AO 32 femur shaft fractures were prospectively enrolled, and a comparison of quality of life and functional status was made. In phase 3, a cost-effectiveness analysis was performed between those treated with intramedullary nail and those treated with skeletal traction.

Conclusion:
This study serves as an example of an economic study in orthopaedic surgery conducted in a resource-poor environment through academic collaboration.