bluuebunny/crossref_metadata_2025_split huggingface dataset:
Appropriateness of Colposcopy Referrals to a Tertiary Care Center. A Review of Adherence to the 2012 ASCCP Guideline [18H]
Authors: Conrad Sarah , Hylton Jordan , King Elizabeth , Isaacs Christine Robillard 
Published: May 2019

INTRODUCTION:
The 2012 American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines were developed to identify cervical pathology and minimize overtreatment of lesions that may resolve spontaneously. These guidelines serve to streamline referrals to facilities for colposcopy and further management. Our objective was to evaluate adherence to the 2012 ASCCP guidelines regarding referrals for colposcopy to a large academic center.

METHODS:
A descriptive study was performed using women referred to Virginia Commonwealth University for Colposcopy or Loop Electrosurgical Excision Procedure (LEEP) from January 2015 to December 2016. Data on patient demographics, cervical cytology, HPV status, prior cervical dysplasia, and the recommended intervention were gathered.

RESULTS:
Referral requests for 432 women were reviewed. Of the referrals, 17.6% were discordant with ASCCP guidelines. The most common discordant colposcopy referrals were for low-grade squamous intraepithelial lesion (LSIL, 47.4%) and atypical squamous cell of undetermined significance (ASCUS, 30.3%). Of the discordant LSIL referrals, 63.9% were patients age <25, of which seven received non-indicated colposcopies. Discordant ASCUS referrals were most commonly HPV negative (n = 5), did not have appropriate co-testing or reflex testing (n = 7) or were age < 25 (n=7). Ten patients were referred for cervical cytology collected on vaginal cuffs despite hysterectomies performed for benign reasons.

CONCLUSION:
Effectiveness of the ASCCP guidelines depends on knowledge and adherence. Patients referred outside of the guidelines were most often women age <25 with LSIL. Referrals outside of evidence-based guidelines may lead to unnecessary procedures and added healthcare expense. Our results help identify areas for provider education.
Blood Transfusion in Gynecologic Surgery: Adherence to Guidelines in Academic and Community-Based Practice [19H]
Authors: Vaughan Kristen Ann , Gillispie Veronica , Manayan Olivia 
Published: May 2019

INTRODUCTION:
Blood transfusions are commonly administered during gynecological surgery. Traditionally, multiple units of packed red blood cells (pRBC) were transfused simultaneously, with a goal hemoglobin level (Hb) of 10 g/dL. However, research shows that this is associated with worse patient outcomes. In 2015, Ochsner implemented restrictive transfusion guidelines to improve patient outcomes and reduce costs. This protocol recommends transfusing one unit pRBC at a time, with an Hb goal of 7 (8 g/dL in patients with acute coronary syndrome or who are symptomatic). A retrospective study was conducted to assess gynecologists' understanding and adherence to these guidelines in academic versus community practices.

METHODS:
IRB approval was obtained from the Ochsner Clinic Foundation. Gynecologists completed an anonymous survey assessing their knowledge of Ochsner's transfusion guidelines. To evaluate adherence to the guidelines, a retrospective chart review was conducted on gynecologic surgeries that utilized pRBC transfusion in 2017.

RESULTS:
Compared to 2016, awareness of Ochsner's transfusion guidelines amongst practitioners (81.36% vs 72.7%) was increased. Knowledge of the guideline parameters also improved. 175 charts were reviewed from community (n=91), academic (n=53), and oncologic (n=31) sites. Academic sites adhered to guidelines more often than community sites (49% vs 31.8%, P<.017). The most common departure from the guidelines was transfusing multiple units of pRBC at once.

CONCLUSION:
Although most practitioners were aware of Ochsner's transfusion protocol, they violated these guidelines in practice. Despite overall knowledge of the guidelines, there continues to be a lack of adherence amongst providers. Further studies are needed to identify and address reasons for non-adherence.
B-Type Natriuretic Peptide (BNP) and Hypertensive Disorders in Pregnancy [31H]
Authors: Lai Monica , Schachter Aubrey , Heard Asha J. , Grant Joshua , Hagan Joseph , Stafford Irene A. 
Published: May 2019

INTRODUCTION:
B type natriuretic peptide (BNP) is a sensitive marker discerning early cardiac dysfunction and has demonstrated correlation with volume expansion and pressure overload in hypertensive disorders in pregnancy. The purpose of this study is to examine variations of BNP values in women with chronic hypertension and severe preeclampsia as indications for delivery.

METHODS:
Pregnant women greater than 20 weeks gestation and women up to 14 days postpartum presenting at Touro Infirmary in New Orleans between April 1, 2015 and May 30, 2017 for hypertension evaluation were eligible for inclusion. After informed consent, BNP values were collected at any evaluation for hypertension during the antepartum period, at admission for delivery and up to 14 days postpartum. 132 women were included. A BNP value above 100 pg/dL was considered elevated. Standards for hypertension and preeclampsia were determined by criteria described by the American College of Obstetrics and Gynecology.

RESULTS:
Of 18 women with chronic hypertension exacerbation as an indication for delivery, none had an elevated BNP, as compared to 24.6% of women without the indication (n =132, p=0.0248). Of 43 women with severe preeclampsia as an indication for delivery, 37.2% had an elevated BNP, as compared to 13.5% of women without the indication (p=0.003).

CONCLUSION:
Women with chronic hypertension exacerbation as an indication for delivery are not likely to have elevated BNP. Women with severe preeclampsia as an indication for delivery are more likely to have elevated BNP, which is congruent with the notion that BNP is a measure of acute stress to the heart.
Effect of Attending Mentorship Program on Physician Confidence Performing Laparoscopic & Vaginal Hysterectomies [2I]
Authors: Heft Jessica , White Nicola C. , Panza Joseph Robert , Alvarez Ronald David , Zimmerman Carl 
Published: May 2019

INTRODUCTION:
Hysterectomies for benign indications have become increasingly performed by fellowship-trained Subspecialists, possibly due to the lack of mentorship among surgeons. We sought to evaluate the change in confidence level of Specialist Attendings (Sas) with the enactment of an Attending Mentorship Program (AMP) for laparoscopic hysterectomies (LHs) and vaginal hysterectomies (VHs).

METHODS:
Sas were invited to participate in this IRB-approved study. Baseline and 6-month post-AMP confidence levels were obtained using a Visual Analog Scale (VAS). LH mentors were members of the MIGS Division. VH mentors were members of the FPMRS Division. Secondary outcomes of operative time, estimated blood loss (EBL), length of admission (LOA), and postoperative complication rates were recorded.

RESULTS:
Thirteen Sas met inclusion criteria for this study and agreed to participate. From July 1st, 2017 to December 31st, 2017, 12 of these surgeons participated in the AMP performing a total of 35 hysterectomies. Ten Sas performed 27 LHs; seven Sas performed eight VHs. VAS scores increased 1.05 cm (p = 0.002) for LHs and increased 0.34 cm (p = 0.33) for VHs. The differences in operative time and EBL were not statistically significant in the AMP groups compared to the non-AMP groups. LOA and postoperative complication rates were similar between all groups.

CONCLUSION:
Confidence levels of Sas in performing LHs increased when the AMP was implemented. Though an increase in VAS confidence scores for VH was seen, this was not statistically significant. Mentoring can be an important factor in SA hysterectomy confidence.
HIV Pre-exposure Prophylaxis (PrEP): Knowledge and Attitudes Among Healthcare Providers [8I]
Authors: Tiu Janeine , Robles Juan 
Published: May 2019

INTRODUCTION:
HIV is a public health concern and studies have shown poor knowledge about pre-exposure prophylaxis (PrEP). Truvada is FDA-approved as PrEP. We explore the knowledge and attitudes towards PrEP among healthcare providers.

METHODS:
119 healthcare providers in Los Angeles completed an IRB-approved online survey. The survey assessed the participants' demographic information, level of training, specialty, practice setting, and their knowledge and attitudes about PrEP. We evaluated the relationship between the overall knowledge score vs. the overall attitude score before and after adjusting for the specified covariates using a linear regression model and a backwards procedure for final variable selection with p<0.1.

RESULTS:
Of the 119 respondents, 82% were female, 72% were 25-34 years old, 59% were Caucasian, 58% were in OB/GYN, and 91% were from an academic medical center. Our population showed good knowledge about PrEP where 66% of knowledge based questions were answered correctly by providers. Our participants had an increased attitude score, with a mean of 14 points (range 9-18). A higher overall knowledge score correlated to a higher overall attitude score (p=0.0021). Each one standard deviation increase in the knowledge score was associated with an approximately 2/3 of a point increase in the attitude score (mean change = 0.69, p<0.001). No demographic factors affected the knowledge score.

CONCLUSION:
In our population, provider knowledge is high and attitudes are positive towards HIV PrEP. Increased knowledge correlated to a more positive attitude towards PrEP. This can be used to guide future research to explore prescription patterns and identify barriers to implementation.
Informed Consents or Consent of Information? Assessing Quality of Informed Consents for Scheduled Cesarean Section [9I]
Authors: Jackman Janelle Mary , Martinez Carolina Cay , Byer Erroll , Balhotra Kimen 
Published: May 2019

INTRODUCTION:
Informed consents of patients undergoing procedures are important not only for ethical and legal reasons but also for the quality of care. Patients' understanding allows for better cooperation, improves results and satisfaction and also helps prevent errors. Providers must ensure that the patient understands the nature of their condition, the risks and benefits of the procedure, the alternatives and agrees voluntarily. Although consents are a well-established practice, it often fails to meet its purpose. Providers must realize that signing a consent form is not equivalent to receiving informed consent.

METHODS:
A cross sectional survey of patients admitted for scheduled cesarean section. The anonymous questionnaires were administered within 30 minutes to 48 hours of having the consent explained. The questions focused on patient's recall of information about the explanation of the procedure, risks and alternatives, preferences about the decision process and overall satisfaction with the manner in which the consent was obtained.

RESULTS:
Only 9% of the patients didn't receive explanations about risks but 42% didn't have discussions of alternative options. Most patients (70%) weren't asked to repeat the explanation. Expectations about decision varied, with 65% favoring shared decision and nearly 26% preferring autonomous decision. Satisfaction was rated as good or very good by 94% of patients.

CONCLUSION:
In conclusion, most patients do not remember receiving explanations about alternatives for procedures nor are they asked to repeat explanations. We recommend that the quality of consents be regularly assessed, to ensure informed consent is being obtained.
Breastfeeding and Marijuana Use: Medical and Ethical Policy Analysis [10I]
Authors: Gross Marielle S. , Rosenblum Nadine , Bossano Carla M. , Milio Lorraine A. 
Published: May 2019

INTRODUCTION:
U.S. guidelines recommend breastfeeding women avoid marijuana given concerns about infant neurodevelopment. Unfortunately, this has resulted in many physicians and hospitals prohibiting women who use marijuana from breastfeeding despite inconclusive evidence of harm and well-known benefits of breastfeeding. Meanwhile, marijuana use is increasing among reproductive-aged women, and complex personal/socioeconomic factors affect feeding choices. We assess evidence and ethical justification for current practice.

METHODS:
We review: (1) Harm to infants from breastmilk marijuana exposure vs. avoiding breastfeeding, (2) Maternal health and psychosocial considerations, and (3) Current practices in light of principles of beneficence, justice, and autonomy.

RESULTS:
(1) Limited data suggests neurobehavioral changes among infants whose mothers use marijuana during breastfeeding, though socioeconomic confounders and difficulty of distinguishing in utero from breastmilk exposure hinder interpretation. Avoiding breastfeeding increases infants' risk of sudden infant death syndrome, sepsis, necrotizing enterocolitis, diabetes, asthma, and obesity. (2) Without breastfeeding, women have increased risk of cardiovascular disease, reproductive cancers, diabetes, depression and unintended pregnancy. Marijuana use is highest among underserved minority women who disproportionately suffer these health consequences and are especially vulnerable to punitive damages. (3) Benefits of breastfeeding for infants and women should be considered alongside risks of marijuana exposure through breastmilk. Lack of these considerations may exacerbate health disparities. Unbiased, culturally-informed counseling would promote open patient-provider communication and shared decision-making, and may improve long-term health.

CONCLUSION:
Restrictive breastfeeding policies for women who use marijuana which do not utilize an individualized, shared decision-making approach are not ethically justified, and may disproportionately undermine health of underserved women and infants.
Development of a Risk Assessment Tool for Surgical Site Infections (SSI) in an OBGYN Patient Population [18I]
Authors: Schweer David , Byun Sharon Y. , Davis John D. , Weber LeBrun Emily Elise 
Published: May 2019

INTRODUCTION:
Surgical site infections (SSI), are defined as superficial, deep, or organ space infections that occur within 30 days of surgery. SSIs are known to greatly increase health care costs and hospital length of stay. In additional to using standard sterile surgical technique and antibiotic prophylaxis, additional strategies been proposed to reduce risk of SSI which include the use of negative pressure wound therapy devices.

METHODS:
We identified all post-cesarean delivery and post-hysterectomy SSI cases as per infection control criteria at the University of Florida between January 1 and December 31, 2017. We developed a SSI risk assessment tool based on based on review of these cases using a defect analysis tool, literature review of SSI risk factors and surgical risk calculators.

RESULTS:
There were 21 OBGYN surgical site infections in 2017. Of these infections, 14 occurred after cesarean delivery and 7 after hysterectomy for a rate of 1.56 and 2.46 respectively. The mean BMI was 41.3 and 39.27 for cesarean delivery and hysterectomy, respectively. Only, 33% of cases were scheduled surgery with the remaining classified as non-scheduled urgent or emergent cases.

CONCLUSION:
An EPIC “smartphrase” was created in our electronic medical record system to help identify patients at increased risk for SSI. Use of this smartphrase should prompt surgeons to consider additional wound infection prophylaxis such as the use of a negative pressure would therapy device. Future direction would include whether or not the use of such a smartphrase increases the use of additional wound infection protective strategies and reduced SSI risk.
Effect of Warmed Hysteroscopic Fluid Distention Medium on Postoperative Core Body Temperature: A Randomized Trial [8J]
Authors: Salazar Christina A. , Wong Marron C. , Miller Valencia E. , Morris Stephanie N. , Isaacson Keith B. 
Published: May 2019

INTRODUCTION:
The purpose of this research study was to determine whether warming of the distention fluid during operative hysteroscopy will have an effect on perioperative core body temperature, and secondarily to assess postoperative self-rated pain scores.

METHODS:
Single-blind, 3-arm stratified randomized trial. Total of 96 patients were randomly allocated to 3 groups. Group 1 received normal saline fluid bags at room temperature 22°C (71.6°F), group 2 received fluid bags pulled from a warming cabinet set at 40°C (104°F), and group 3 received continuously warmed fluid at 40°C (104°F). Randomization was stratified by procedure type (myomectomy and non-myomectomy) to ensure 50% of the cases in each group included resections of submucous leiomyoma.

RESULTS:
There was no statistically significant difference between the 3 arms of the trial in near-core body temperature (P=.29) or in self-rated pain scores (P=.09). However, when compared to all other procedure types, the myomectomy procedures had statistically significant higher fluid deficits in group 1 (P=.01) and group 2 (P=.02), as well as significantly longer operative times in group 1 (P=.05) and group 2 (P=.03). Group 3 demonstrated no statistically significant difference in average fluid deficit between hysteroscopic myomectomy to all other procedure types (P=.16), despite there not being a statistically significant difference in total procedure time between myomectomy procedures and all other surgical procedure types (P=.42).

CONCLUSION:
Warming of hysteroscopic distention media did not impact near-core body temperature or post-operative pain scores. Use of continuously warmed hysteroscopic fluid in hysteroscopic myomectomy may decrease operative times as well as volume of fluid deficits.
Letrozole for the Treatment of Thoracic Endometriosis: A Case Report [15J]
Authors: Chadwick Tara Hardiman , Audlin Kevin 
Published: May 2019

INTRODUCTION:
Thoracic endometriosis syndrome describes ectopic endometrial tissue within the thoracic cavity causing significant morbidity including cyclic chest pain, pneumothorax, hemothorax, and hemoptysis. Thoracic endometriosis is a rare condition usually requiring multiple interventions and hormonal suppression of the endometrial implants. Given the overexpression of aromatase P450 within endometrial tissue, off label use of aromatase inhibitors has been proposed as a mechanism for hormonal suppression with successful treatment of symptoms in cases of pelvic endometriosis.

METHODS:
A case report of a 48 year old with recurrent thoracic endometriosis following hysterectomy with bilateral salpingo-oophorectomy. Her disease was significant, resulting in pneumothorax requiring bleb resection and pleurodesis, as well as subsequent hemothorax requiring chest tube placement. She was maintained on Lupron therapy after surgical sterilization with recurrent hemothorax again requiring thoracentesis. She was subsequently switched to Letrozole with resolution of symptoms and no further episodes of hemothorax. The patient consented to publication of a case report.

RESULTS:
After 21 months of Letrozole treatment, the patient has remained asymptomatic without recurrence of hemothorax. Following surgical sterilization, the main source of estrogen is peripheral conversion of androgens to estrogen through the aromatization process. Thus, aromatase inhibitors can be used to eliminate this pathway for estrogen synthesis that can stimulate endometriosis.

CONCLUSION:
While aromatase inhibitors have been demonstrated to reduce the pain associated with pelvic endometriosis, this case report demonstrates its potential efficacy in treating thoracic endometriosis as well. Additional research is needed to determine the potential for aromatase inhibitors to become a mainstay in the treatment of thoracic endometriosis.
Cervical Length Screening: Barriers to, and Patient Perception of, Cervical Length Measurement [31J]
Authors: Bradley Danielle , Cobb Christina , Landau Erin , Wolfberg Adam 
Published: May 2019

INTRODUCTION:
Universal cervical length screening is not yet the standard of care in the United States, but meta-analyses suggest that such a practice could reduce the incidence of preterm delivery and is cost-effective. The objectives of this study were to 1) determine the prevalence of cervical length screenings among users of the mobile app, Ovia Pregnancy, and 2) identify barriers to receiving a cervical length measurement.

METHODS:
A survey about experience with cervical length measurement and barriers to receiving a measurement was sent to users of a pregnancy mobile app. Respondents were age 18 or older, United States residents, and pregnant (n=2,145).

RESULTS:
A total of 796 (37%) of respondents indicated that their healthcare provider measured the length of their cervix. Among 1,349 (63%) women who have not had a cervical length measurement, 349 (26%) reported that they would be unlikely to ask their healthcare provider to measure their cervical length, 727 (54%) reported that they would be likely to ask, and the remaining 273 (20%) were neutral on the topic. The most frequently reported barriers to a cervical length measurement were that their healthcare provider had not suggested it (44%), they had never heard of a cervical length measurement prior to taking the survey (21%), and concerns that the screening would not be covered by insurance (15%).

CONCLUSION:
Survey results indicate that more can be done to educate patients about the importance of cervical insufficiency during pregnancy, as well as to encourage providers to regularly measure their patients' cervical length.
May-Thurner Syndrome in Pregnancy [7K]
Authors: Mama Saifuddin Taiyeb , Pistilli Stephanie 
Published: May 2019

INTRODUCTION:
Thromboembolic disease is responsible for approximately 11% of maternal deaths in the United States. May-Thurner syndrome occurs when compression by the right common iliac artery against the fifth lumbar vertebra causes left common iliac vein obstruction and thrombosis. The incidence is 22-24%. It increases the risk for deep vein thrombosis. Pregnancy and oral contraceptives are risk factors. Diagnosis is by CT, MRI and venography. If anticoagulation therapy is not effective, angioplasty and endovascular stenting are needed. If undiagnosed and untreated, the patient can develop post-thrombotic syndrome with chronic edema, pain, hyperpigmentation, varicosities and skin ulcerations.

METHODS:
A 34 year old female G3 P0020 at 27 weeks gestation presented with left thigh, groin and gluteal region swelling and pain. Doppler studies were negative. Symptoms persisted and MRI/MRV diagnosed thrombosis of the left common and external iliac veins. The only antecedent precipitating event was a 2.5 hour plane flight 10 days prior. Screening for hypercoagulable disorders was negative. The patient was placed on Lovenox antepartum, anti Xa levels followed and continued postpartum for 6 weeks. MRV 2 months postdelivery revealed partial recanalization of vessels. In her second uneventful pregnancy, the patient initiated early care, was started on Lovenox, and delivered vaginally.

CONCLUSION:
May-Thurner syndrome is a rare condition with significant morbidity and mortality. Apart from pregnancy, this patient had no risk factors. The continuing symptoms prompted an appropriate diagnosis by MRV. Immediate anticoagulant treatment helped to prevent post-thrombotic syndrome. A high index of suspicion is needed to avoid misdiagnosis.