bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Effect of Chronic Hypertension on Control of Severe Range Blood Pressures in Preeclampsia [36P]
Authors: Cui Yiwen , Litman Ethan , Feustel Paul , Bringley Johanna , Rijhsinghani Asha 
Published: May 2019

INTRODUCTION:
We aim to assess the impact of maternal hypertension category on the control and response of urgent hypertension.

METHODS:
This is a retrospective cohort study of patients who required immediate-acting antihypertensive medications outlined by the ACOG Committee Opinion #692 during the peripartum admission between June 2015 to June 2017. The patients were either diagnosed with preeclampsia with severe features (“preSF”) or chronic hypertension with superimposed preeclampsia with severe features (“cHTN+preSF”). We abstracted maternal medical history and medication dosing. Statistical significance was calculated with the Student's t-test or Mann-Whitney test. Multivariable regression analysis was used to adjust for the effect of confounders.

RESULTS:
We identified 326 patients, 211 with preSF and 115 with cHTN+preSF. In the antepartum period, patients with cHTN+preSF received significantly more doses of immediate-acting antihypertensive medications than those with preSF (3 vs 2 doses, p<0.01). The cHTN+preSF group also required more time for blood pressures to exit severe range (55 vs 30 minutes, p<0.01) and more frequent re-dosing of anti-hypertensive medication (2 vs 1 times, p=0.02). The differences remained significant in the multivariable regression model when controlled for age, gravidity and BMI. During the postpartum period, the same parameters were similar between the groups.

CONCLUSION:
While chronic hypertension is recognized as a risk factor for the development of preeclampsia, we demonstrate that it also complicates and prolongs the course of blood pressure management particularly in the antepartum period. Consideration should be given to maternal history when tailoring treatment of severe hypertension in patients with pre-eclampsia.
The Effect of Labor and Delivery Nursing Experience on Labor Progression and Cesarean Section Rates [39P]
Authors: Calo Corinne A. , Elliott John O. , Clifton William D. , Umunnabuike Chioma , Krantz Carl A. 
Published: May 2019

INTRODUCTION:
Prevention of the primary cesarean section (PCS) is a quality indicator of both provider and facility performance. Although nurses spend a significant amount of time with patients in labor, data is lacking regarding the influence of nursing labor and delivery experience on PCS rate.

METHODS:
A retrospective, institutional review board approved, cohort study of 3,275 nulliparous, term patients with singleton fetus in vertex presentation was conducted. Labor progression was calculated during the active phase of labor. Nursing experience, categorized into <2 years, 2-5 years, and >5 years, was calculated using a weighted average of years of experience and time spent caring for the patient. Patients who underwent PCS for failure to progress, cephalopelvic disproportion, and arrest of dilation/descent were included. Labor progression and PCS rates were compared via one-way ANOVA, chi-square tests, and logistic regression analysis.

RESULTS:
Labor progressed at a faster rate when nursing experience was >5 compared to 0-2 and 2-5 years (1.3±1.2, 1.0±0.8, and 0.8±0.8 cm/hr, respectively; P<.001). PCS rate was significantly lower for nurses with >5 compared to 0-2 and 2-5 years of experience (10%, 15.9%, and 14.1%, respectively; P<.001). Utilizing >5 years as the reference group translated to an increased odds of PCS in the 0-2 (OR 1.69, 95% CI 1.28-2.23) and 2-5 years experience groups (OR 1.48, 95% CI 1.09-1.99).

CONCLUSION:
This study demonstrates that labor and delivery nursing experience is associated with labor progression and PCS rate. Follow-up studies are needed to determine if differences in practice and more rigorous education/didactics could reduce these differences.
The Effect of the Cost of Professional Liability Insurance on the Ob/Gyn Workforce in the U.S. From 2005 to 2015 [4Q]
Authors: Kim Edward , Rayburn William , Xierali Imam 
Published: May 2019

INTRODUCTION:
Professional liability climate is an important factor that can influence the physician workforce and thereby access to healthcare. We sought to investigate the relationship between the cost of professional liability insurance (PLI) and obstetrics and gynecology (Ob/Gyn) workforce in the U.S. from 2005 to 2015.

METHODS:
We obtained the PLI cost data from Medical Liability Monitor and calculated the Ob/Gyn workforce density from the American Medical Association's Physician Masterfile and the U.S. Census for the years 2005 to 2015.

RESULTS:
Nationally, there has been an approximately 21% decrease in the cost of PLI, 10% increase in the absolute number of Ob/Gyns and 0.62% increase in the Ob/Gyn workforce density in this period. A negative binomial regression model showed a significantly positive relationship between these two variables, with an incidence rate ratio (IRR) of 1.005 (p = 0.006). In other words, the Ob/Gyn workforce density increased by 0.5% with every $10,000 increase in the cost of PLI.

CONCLUSION:
We remain cautiously optimistic for the future of the Ob/Gyn workforce and professional liability climate. Investigation of the effect of the cost of PLI on the Ob/Gyn workforce relocation pattern is an important future direction for research.
The Association Between Smoking and Postoperative Complications in Laparoscopic Hysterectomies [9Q]
Authors: Lababidi Suzanne , Winfrey Olivia K. , Shammout Fadel 
Published: May 2019

INTRODUCTION:
Smoking is a known risk factor for complications in major abdominal procedures, however the association has been poorly described in minimally invasive procedures. This project aims to describe the association between smoking and post-operative complications in laparoscopic hysterectomies.

METHODS:
This project utilized the National Surgical Quality Improvement Project database for 2007 and 2016 to examine patients who underwent a laparoscopic hysterectomy. Incomplete data was the only exclusion criterion. Binary logistic regression and Chi-square test were used for data analysis. Significance was set at P=.05.

RESULTS:
A total of 51,699 patients were included in analysis. Of these, 581 (0.8%) developed superficial surgical site infection (SSI), 563 (0.8%) developed organ space SSI, 137 (0.2%) developed a wound dehiscence, 90 (0.1%) developed pneumonia post-operatively, 1,519 (2.2%) required readmission, and 695 (1.0%) required re-operation. When controlling for age, hypertension, and diabetes, smoking was significantly associated with organ space SSI (OR 1.477, 95% CI 1.215-1.794, P=.002), pneumonia (OR 2.021, 95% CI 1.287-3.174, P=.001), and hospital readmission (OR 1.297, 95% CI 1.143-1.472, P<.001). The association between smoking and superficial SSI (P=.065), wound dehiscence (P=.318), or reoperation (P=.756) was not statistically significant.

CONCLUSION:
These data demonstrates the significant association smoking has with important postoperative complications in laparoscopic hysterectomies. When controlling for other risk factors, smoking was still associated with increased risk of infection, pneumonia, and readmission. Smoking cessation is an important preoperative goal and has the potential to significantly improve surgical outcomes.
Uterine Leiomyoma With KAT6B-KANSL1 Fusion: Report of a Rapidly Enlarging Uterine Mass in a Postmenopausal Woman [14Q]
Authors: Ainsworth Alessandra J. , Bakkum-Gamez Jamie , Schoolmeester Kenneth 
Published: May 2019

INTRODUCTION:
Leiomyomas are benign uterine smooth muscle tumors. After menopause, most women have a reduction in size and number of leiomyomas. Conversely, uterine sarcomas present as a rapidly enlarging pelvic mass in postmenopausal women. The distinction of uterine leiomyoma from sarcoma is difficult and definitive diagnosis requires pathologic examination.

METHODS:
A 74 year-old multiparous female with a history of ductal carcinoma in situ (DCIS) of the breast presented with significant postmenopausal bleeding, requiring blood transfusion, and a rapidly enlarging pelvic mass. Abdominal imaging including ultrasound and computerized tomography confirmed a 15 cm uterine mass. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with concern for uterine sarcoma. Grossly, the uterus contained a 15.5 cm well demarcated intramural mass. Microscopically, the tumor was a spindle cell neoplasm with anastomosing fascicles interrupted by thick-walled blood vessels or fibrous regions. The cells exhibited uniformly mild to moderate cytologic atypia. Immunohistochemically, the tumor strongly and diffusely expressed desmin and h-caldesmon and exhibited patchy, strong expression of CD10. RNA-seq, confirmed by RT-PCR and Sanger sequencing, revealed a gene fusion involving KAT6B and KANSL1. The fusion joins exon 3 of KAT6B to exons 11 and 12 of KANSL1. The final diagnosis was a benign uterine leiomyoma. The patient remains without evidence of disease six months post-operatively.

CONCLUSION:
This is the first case, to our knowledge, that has identified the KAT6B-KANSL1 fusion in a uterine leiomyoma. Further efforts to classify the pathologic characteristics and prevalence of this fusion may contribute to understanding of tumorigenesis of uterine smooth muscle tumors.
Bundled Prevention of Cesarean Surgical Site Infections: The Down and Dirty [20Q]
Authors: Gee Stephen Elliott , Orellana Robert , Kellert Brian Andrew , Mangino Julie , Meyers Carol , Rood Kara M. 
Published: May 2019

INTRODUCTION:
Surgical site infections (SSI) following cesarean delivery (CD) are a major cause of morbidity and economic burden. Our tertiary-care hospital implemented a multidisciplinary SSI surveillance system and preventative bundles to reduce rate of SSI after CD. Our objective was to measure the effect of 3 bundles on post-CD SSI.

METHODS:
A retrospective single-center cohort study of all CD July 2012 to December 2017 was performed. Infections were identified via 30-day active surveillance using CDC definitions by one infection preventionist and reviewed by one physician. Patient demographics and procedural details were stored for submission to CDC. Unadjusted and adjusted risk factors were identified using logistic regression. Bundle 1 (2014) included enhanced surgical instrument sterilization, bandage removal POD2, preoperative sage cloth, 3 grams Cefazolin for women >120 kg, recommended patient warming, staples removal POD7, and provided silver dressings. Bundle 2 (2015) included nurses prepping with prolonged prep time using two chlorhexidine applicators. Bundle 3 (2016) included preoperative vaginal prep and 500 mg Azithromycin in unscheduled CD in labor and encouraged post-placental glove change.

RESULTS:
Over 5.5 years, 2.2% (176/8150) of women developed post-CD SSI. 79% (138/176) were superficial incisional primary SSI. The first bundle had no significant effect on the odds of post-CD SSI (odds ratio [OR] 0.48, confidence interval [95% CI] 0.15 - 1.61). We observed decreased odd of post-CD SSI for both bundle 2 (OR 0.63, 95% CI 0.45 - 0.87) and bundle 3 (OR 0.61, 95% CI 0.42 - 0.88).

CONCLUSION:
Evidence-based bundles should be considered at institutions experiencing high post-CD SSI rates.
Obstetric Outcomes in Nepali Immigrant Patients: A Retrospective Study Within the Rochester Regional Health System [26Q]
Authors: Lewis Gregory Kirk , Dawkins Josette Camion , Boddu Rohini , Cabral Paul A. 
Published: May 2019

INTRODUCTION:
Ethnic minorities particularly immigrants, tend to be at increased risk for poor birth outcomes. Rochester New York is home to many Nepali immigrants with a 56% increase in 2014. These immigrants face many barriers which includes communication, health literacy and accessibility to health services. The purpose of this study was to evaluate the obstetric outcomes of Nepali patients within the Rochester Regional Health System.

METHODS:
Nepali women who delivered between January 1, 2011 and December 31, 2016 were matched with Non-Nepali women who delivered during the same time period. Demographic and obstetric information was extracted from the electronic medical records. Obstetric outcomes between the 2 study groups were then analyzed. Data analysis was done using the SPSS, version 24.

RESULTS:
The final analysis was performed on 194 patients (86 Nepali and 108 Non-Nepali). Nepali patients had prolonged second stage of labor (P<.05) and a higher cesarean section rate (33.7% vs 26.9%) compared to Non-Nepali patients. Nepali patients also had significantly higher rates of chorioamnionitis/endometritis (P<.05) as well as third degree vaginal lacerations (P<.05). More postpartum hemorrhage was seen in the Nepali group of patients, 17.4% vs 12.0%. Babies born to Nepali mothers were more likely to be admitted to the Neonatal Intensive Care unit (P<.05).

CONCLUSION:
Nepali mothers had higher obstetric complications than Non-Nepali mothers. Further ongoing analysis of health outcomes within this particular migrant population is warranted. This will certainly help to inform better reproductive health care practices for these patients, and ultimately minimize disparities in their obstetric care and outcomes.
Opioid Withdrawal During Pregnancy and Rates of Neonatal Abstinence Syndrome (NAS): A Pilot Study [27Q]
Authors: Stephens Angela Jessica , Tibavinsky Bernal Lina Maria , Street Linda , Browne Paul 
Published: May 2019

INTRODUCTION:
Opioid dependency in pregnancy has detrimental effects to mother and fetus. Neonatal Abstinence Syndrome (NAS) is a complex disorder caused by the abrupt termination of fetal exposure to opioids. The incidence has risen in the United States (US) during the past decade. Current policies and the paucity of Licensed Narcotic Treatment Programs leaves limited options for opioid-dependent patients.

METHODS:
A retrospective cohort study was conducted to assess the ability to offer opioid withdrawal during pregnancy and the effects of withdrawal on rates of NAS. The NIH's I2B2 software was used to identify patients with opioid dependency seen at our institution from January 1, 2014 to January 31, 2018. Clinical outcomes between opioid maintenance and opioid withdrawal cohorts were then conducted.

RESULTS:
51 pregnancies were identified with opioid dependency from January 2014 to January 2018. 29 patients enrolled in an opioid withdrawal program. 22 patients enrolled in an opioid maintenance program. 3 in the withdrawal and 1 in the maintenance cohort remain pregnant. 2 in the withdrawal cohort were lost to follow up. There was 1 abortion in the maintenance and 1 perinatal death in the withdrawal group. NAS rates were 30.0% (6/20) in the maintenance cohort and 43.5% (10/23) in the withdrawal cohort. Rate of NAS were 18.2% (2/11) in the successful withdrawal and 66.7% (8/12) in the failed withdrawal cohort. 25% (3/12) of failed withdrawal cohort relapsed, and 66.7% (2/3) had infants with NAS.

CONCLUSION:
Successful, supervised opioid withdrawal during pregnancy is possible, and may reduce rates of neonatal abstinence syndrome.
Improving Detection of Surgical Site Infections After Cesarean Delivery: What Are Diagnosis Codes Missing? [28Q]
Authors: Duffy Cassandra , Ross Naima , Messina Maria , Ewing Julie , Saiman Lisa , Goffman Dena 
Published: May 2019

INTRODUCTION:
Surveillance for surgical site infections (SSI) following cesarean can be challenging. We sought to identify cases of SSI over two years and describe our methods of case ascertainment.

METHODS:
We queried our hospital's data warehouse for cesareans deliveries from 2016-2017 among women >18 years of age. Three methods for case finding were used: i) ICD-10 diagnoses codes, ii) reporting complications in postoperative notes, and iii) infection control surveillance activities. For ICD-10 codes, we sought endometritis following delivery and infection of obstetrical surgical wound, infection following procedure, cellulitis, and/or peritoneal abscess. We included endometritis as an organ/space SSI by CDC definitions. Chart review was performed for all cases identified by any of the 3 methods to confirm SSI diagnosis as per CDC criteria.

RESULTS:
Among 3,507 cesareans, ICD-10 codes identified 76 confirmed cases of endometritis and 31 SSI. The positive predictive value for endometritis was 88.0% (95% CI 80.2-93.1) and for SSI codes, 53.5% (95% CI 43.0-63.6). Adding puerperal sepsis produced one additional SSI case, and searching the postoperative note yielded another 26 cases of endometritis and one wound infection. Six SSI were identified by infection control not identified by other methods. In total, we identified 141 SSI, including 98 endometritis-only cases. The incidence of all SSI, endometritis, and SSI excluding endometritis was 4.02%, 2.79%, and 1.23%.

CONCLUSION:
Improved ascertainment methods are needed to inform and assess performance improvement efforts for cesarean SSI. Reliance on diagnosis codes may miss a significant number of cases and is poorly predictive of SSI other than endometritis.
Oral Carbohydrate Intake Impact on Cesarean Delivery Perioperative Well-Being: A Randomized Interventional Study [29Q]
Authors: Wendling Adam , Byun Sharon Y. , Koenig Megan , Vasilopoulos Terrie , Wishin Judith 
Published: May 2019

INTRODUCTION:
Oral carbohydrates (CHO) prior to a variety of surgical procedures has been found to attenuate the postoperative catabolic state with an improvement in well-being insulin sensitivity, cardiac output and shortened hospital stays without adverse effect. Previous work has compared oral CHO to water or flavored water and excluded pregnant women. Our primary aim was to determine if preoperative oral consumption of higher dose CHO would improve patient well-being (WB-VAS) prior to cesarean section compared to a widely available rehydration beverage with a lower CHO dose and fasted controls.

METHODS:
Low risk women undergoing scheduled cesarean deliveries under spinal anesthesia were recruited. Participants were randomized to either: Clearfast® (group CHO), Gatorade Thirst Quencher® (group R) or fasting control (group F). Participants in groups CHO and R received 710 mL of either beverage the night before and 355 mL two hours prior to surgery. Participants in Group F fasted after midnight the night before surgery. Two hours before surgery, baseline WB-VAS was recorded, followed by beverage consumption for groups CHO and R. One hour later, WB-VAS was repeated. Additional recorded measures included umbilical blood glucose, intraoperative variables, breastfeeding success, and quality of recovery one day after surgery.

RESULTS:
Group differences in change in WB-VAS were analyzed using linear regression. Both group CHO and R showed significant improvements in WB-VAS while fasted patients showed no change. There were no differences in other outcomes.

CONCLUSION:
Either the common oral rehydration or higher dose CHO beverage resulted in superior well-being compared to fasting with no difference in other outcomes.
Postoperative Opioids After Laparoscopic Hysterectomy With Transversus Abdominis Plane Block [2D]
Authors: Krajick Kayla Ann , Sullivan Margaret Hancock 
Published: May 2019

INTRODUCTION:
Chronic pelvic pain after hysterectomy affects many women, predisposing them to opioid dependence. The amount of opioids consumed postoperatively can also predispose opioid dependence. Transversus abdominis plane (TAP) block is a non-opioid method to reduce postoperative pain. This study seeks to demonstrate the effectiveness of TAP block for total laparoscopic hysterectomy (TLH) patients in reducing postop pain and opioid consumption.

METHODS:
This retrospective cohort study of women undergoing TLH at a single hospital was given exempt status by the Institutional Review Board. Chronic opioid users were excluded. Primary outcomes were opioid consumption within 24 hours postoperatively and amount of opioids prescribed at discharge. Secondary outcomes included pain scores averaged over 6-hour intervals within 24 hours postoperatively. T-test and chi-square analyses were performed.

RESULTS:
This study included 49 women with TLH of whom 26 received a TAP block. The two groups were demographically similar. Women who received TAP block needed significantly less opioids within the first 24 hours postop (38.4 vs 65.9 morphine equivalents, P=.02). No significant differences were seen between the two groups in postoperative pain scores at 6-hour intervals, or in the amount of opioids prescribed at discharge.

CONCLUSION:
Women undergoing TLH who received a TAP block required approximately half the amount of opioids for pain control within the first postoperative day. TAP block should be considered an effective adjunct for pain control after TLH to decrease the amount of postoperative opioid consumption, ultimately aiding in the prevention of chronic opioid use and opioid dependence.
Retrospective Chart Review of an Adolescent Hematology Clinic [4D]
Authors: Mulvaney Kylie , Nelson Anita L. , Borzutzky Claudia , Escovedo Michelle , Jaffray Julie 
Published: May 2019

INTRODUCTION:
To investigate the causes of and treatments for heavy menstrual bleeding (HMB) among adolescent females referred for hematologic evaluation, focusing on tolerance of first line methods.

METHODS:
A retrospective chart review was conducted of patients seen in Children Hospital Los Angeles' combined Hematology-Adolescent Medicine clinic between January 2015 and May 2018 for HMB and evaluation for underlying bleeding disorders (BD). Upon approval from the CHLA Institutional Review Board, de-identified data was collected and analyzed on a password-protected spreadsheet.

RESULTS:
Of 115 patients referred to the Hematology-Adolescent clinic, 41 were diagnosed with underlying BD, 66 were found to be free of such disorders, and 8 patients had history of thrombosis or beta thalassemia. Of the 41 women diagnosed with DB, 21 were initially prescribed combined oral contraceptives (COC); 12 had reduced blood loss and the remaining 9 were offered a second line treatment due to either failure of COC to control bleeding, or to intolerable side effects. 17 women with bleeding disorders were initially treated with antifibrinolytic agents; 12 responded to these, while 5 patients were prescribed different agents or hormonal methods. The remaining 3 patients with BD did not receive treatment. The 66 patients without underlying BD were typically prescribed iron supplementation and/or oral contraception.

CONCLUSION:
Among 115 patients presenting with HMB, 36% were found to have underlying BD. The first line of treatment across this study population was COC with variable efficacy in reducing symptoms, supporting existing literature and its call for more formalized diagnosis and treatment of HMB.