bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is First Trimester Maternal Serum Alpha Fetoprotein Predictive of Adverse Pregnancy Outcomes? [30L]
Authors: Dinglas Cheryl , Afsar Nur , Davis Jay , Kim Sara , Herrera Kimberly , Chavez Martin 
Published: May 2019

INTRODUCTION:
While elevated second trimester maternal serum alpha fetoprotein (msAFP) has been associated with adverse pregnancy outcomes, the utility of first trimester msAFP (AFP1) in predicting these outcomes is not known. Our objective was to determine the association between AFP1 and ischemic placental disease (a composite of preeclampsia, fetal growth restriction and/or placental abruption). Secondary outcomes included correlation with second trimester msAFP (AFP2), in addition to the association of AFP1 with preterm birth, fetal demise, and spontaneous abortion.

METHODS:
An IRB-approved multi-site retrospective cohort study was performed including all patients with AFP1 as part of routine first trimester aneuploidy screening over from April 2015-August 2016. Pregnancies with multiple gestations and known structural or chromosomal abnormalities were excluded. Delivery records were reviewed for adverse pregnancy outcomes. Spearman correlation coefficient assessed the relationship between AFP1 and AFP2. Fisher exact test and Odds Ratios were used to determine the association between AFP1 and adverse pregnancy outcomes.

RESULTS:
Of 968 patients with AFP1, 847 had complete records available for review (87.5%). There was a positive correlation between AFP1 and AFP2 (rho =0.57, P<.001). There was a significant association between elevated AFP1 (> 2.0 MoM) and ischemic placental disease, 18.9% vs 8.2% (OR 2.6, 95% CI 1.4-4.9). Additionally, there was a significant association between high AFP1 and early onset preeclampsia <34 weeks, spontaneous preterm birth and overall preterm birth.

CONCLUSION:
Elevated first trimester msAFP is associated with ischemic placental disease and preterm birth and may help to identify at risk pregnancies as early as the first trimester of pregnancy.
Is There a Correlation Between Elevated Healthy Start Screen Scores and Development of Postpartum Depression? [32L]
Authors: Roussos-Ross Dikea , Padilla Mikela , Goodin Amie 
Published: May 2019

INTRODUCTION:
The incidence of postpartum depression is 15-20%. ACOG currently recommends pregnant women be assessed for depression at least once during the perinatal period. The Healthy Start Screen (HSS), a mandated screening tool of all pregnant women during initial prenatal care in Florida, assesses women at risk for adverse pregnancy related outcomes. HSS scores >6 (maximum score of 14) trigger referrals for additional services. Our aim was to determine whether elevated prenatal HSS scores correlate with elevated postpartum Edinburgh Postnatal Depression Scale (EPDS) scores, thus identifying women at risk for developing postpartum depression (PPD).

METHODS:
A retrospective chart review of 2,816 pregnant women seen within the Department of OBGYN between January 1, 2016 and March 1, 2018 was completed. Patients who had both a HSS and a postpartum EPDS were included (total n=1,738). A HSS score >6 was considered positive, identifying the patient as at-risk. An EPDS score >12 was considered positive for postpartum depression. Logistic regression estimated the relationship between HSS and EPDS.

RESULTS:
An elevated HSS score at the initial prenatal screening was significantly associated with an elevated EPDS score at postnatal assessment (P<0.001). Each additional point on the HSS, regardless of the total HSS score, resulted in a 13% increase in likelihood of having a positive EPDS (OR 1.13; 95% CI 1.09-1.17).

CONCLUSION:
The HSS is a useful tool to identify women at risk for postpartum depression. At-risk women could be screened more frequently, and depression identified earlier, leading to more timely evaluation and treatment. Future studies are warranted.
Current Practices of Obstetrics & Gynecology Providers Regarding Menstrual Health Management During Clinic Visits [36L]
Authors: Espinal Mariana , Trant Amelia A. , Redman Shelby , Kebede Nardos , Sheth Sangini Shah , Fan Linda L. 
Published: May 2019

INTRODUCTION:
Menstrual health management (MHM) has gained attention internationally given the relationship between lack of access to menstrual products and absenteeism, poor school or work performance, and increased risk of urogenital infections. There is a dearth of information on how Ob/Gyn providers in the United States address MHM. This study seeks to describe Ob/Gyn providers' MHM practices in a low income clinic population and to assess willingness to recommend reusable menstrual products.

METHODS:
A cross-sectional study of Ob/Gyn providers from private and hospital outpatient women's health practices at Yale New Haven Hospital conducted with a 17-item anonymous questionnaire to assess counseling practices regarding menstrual products. Descriptive statistics were used for analysis.

RESULTS:
Among the 52 providers who responded (response rate 69%): 38.4% sometimes ask patients about their choice of menstrual products, 21.2% always ask, 15.4% ask only when patients bring it up, 17.3% don't usually ask and 7.7% never ask. While most providers (88.5%) were familiar with the menstrual cup and 36.5% think that the menstrual cup would work well for some patients, only 13.5% have recommended it. One-quarter would not recommend the menstrual cup and 42.3% would appreciate more information about the menstrual cup prior to recommending it.

CONCLUSION:
The menstrual cup is a reusable alternative that remains underutilized. There is great need for guidelines to encourage and educate providers regarding MHM that may improve patients' quality of life. Ob/Gyn providers could play an essential role in the improvement of MHM if menstrual products use and patient needs were addressed in clinic visits.
Bleeding Patterns With a 1-Year, Segesterone Acetate/Ethinyl Estradiol Contraceptive Vaginal System [3M]
Authors: Nelson Anita L. , Vieira Carolina Sales , Fraser Ian , Burke Anne E. , Gilliam Melissa , Brache Vivian 
Published: May 2019

INTRODUCTION:
A segesterone acetate (SA) 0.015 mg/ethinyl estradiol (EE) and 0.013 mg (per day) contraceptive vaginal system (CVS) can be used for up to 1 year. We analyzed bleeding patterns with CVS use and factors associated with unscheduled bleeding/spotting.

METHODS:
We pooled results from two multicenter, single-arm, open-label, pivotal, phase 3 studies of the SA/EE CVS conducted in 17 US and 7 international sites. Participants followed a 21/7 day in/out schedule of CVS use for up to 13 cycles, and recorded vaginal bleeding daily in paper diaries. Scheduled and unscheduled bleeding/spotting were summarized by cycle. We used multiple logistic regression to identify factors associated with unscheduled bleeding/spotting. To avoid bias from varying study participation lengths, we analyzed the first 4 cycles of CVS use.

RESULTS:
Data from 2070 participants were analyzed. Scheduled bleeding/spotting was documented by 97.9% of women with a mean of 4.6-5.2 scheduled bleeding/spotting days/cycle. Any unscheduled bleeding/spotting ranged from 13.2% to 21.7% of women/cycle; with a mean of 3.4-5.1 days/cycle for those women. Absence of scheduled bleeding/spotting was 5%-8% of women/cycle; absence of any bleeding/spotting (complete amenorrhea) was 2.6%-4.9% of women/cycle. Few women (1.7%) discontinued early due to unacceptable bleeding. Compared with White women, Black/African-American women were more likely to report unscheduled bleeding/spotting (OR 1.49; 95% CI, 1.14-1.94). Body mass index did not influence bleeding patterns.

CONCLUSION:
Participants using the SA/EE CVS up to 13 cycles experienced good cycle control. Discontinuations due to unacceptable bleeding were low. Further research into demographic/other differences with reported bleeding is warranted.
Endometrial Safety With a 1-Year Segesterone Acetate/Ethinyl Estradiol Contraceptive Vaginal System [5M]
Authors: Archer David F. , Barnhart Kurt , Creinin Mitchell D. , Jensen Jeffrey T. , Thomas Michael , Creasy George W. 
Published: May 2019

INTRODUCTION:
A new contraceptive vaginal system (CVS) for 13 cycles of use has been developed that releases a daily mean of segesterone acetate (SA) 0.15 mg and ethinyl estradiol (EE) 0.013 mg. We evaluated endometrial safety during use of the SA/EE CVS for up to 13 cycles.

METHODS:
In this multicenter, open-label, phase 3 study, 2308 women used the SA/EE CVS on a 21-day in/7-day out regimen for up to 13 cycles. Women could choose to participate in an endometrial safety sub-study at 5 study sites. Three blinded pathologists histologically examined endometrial biopsies at screening, at cycle 6 in the first 25 women reaching 6 cycles, and at the end of study (cycle 12/13) or early study termination in the remainder. Women with endometrial hyperplasia or cancer at baseline were excluded. We evaluated histologic changes in women with both screening and follow-up biopsies.

RESULTS:
Of the 156 women who participated, 83 had follow-up biopsies. Pathologists identified no cases of endometrial hyperplasia or carcinoma at cycle 6 (n=24), cycles 12/13 (n=30) or other end of therapy times (n=29). The most frequent histologic diagnoses were atrophic/inactive or secretory: atrophic/inactive (29%, 27% and 28%, respectively), secretory (29%, 37%, and 45%, respectively), proliferative (17%, 7%, and 21%, respectively), mixed (17%, 10% and 3%, respectively), menstrual (4%, 7%, and 0%, respectively), or insufficient/no tissue (0%, 10%, and 3%, respectively).

CONCLUSION:
Use of the SA/EE CVS for up to 13 cycles did not result in any unexpected endometrial safety effects based on endometrial histology.
Effect of Daytime Versus Night-time on Outcome in Patients Undergoing Emergent Neurosurgical Procedures
Authors: Qadri Ali H. , Sproule Stephanie , Girling Linda , West Michael , Cappellani Ronald , Chowdhury Tumul 
Published: May 2019

Background:Timing of neurosurgical procedures is controversial. Challenges identified with night-time surgeries include physician fatigue and sleep deprivation, and fewer staff and resources compared with daytime surgery. These might contribute to medical errors and complications, and, hence, worse patient outcomes.Methods:This single center retrospective study of 304 patients who underwent emergent neurosurgical procedures between January 1, 2010 and December 31, 2016 included 2 groups based on the timing of surgery: daytime (7:00 amto 6:59 pm) and night-time (7:00 pmto 6:59 am) surgery groups. Patient demographics, diagnosis, surgical characteristics, complications, and neurological outcome were obtained from the medical records.Results:There was no difference in patient demographics, intraoperative complications, and length of surgery between the 2 groups. Although there was no statistically significant difference in neurological outcome between the 2 groups at hospital discharge and 1 month postdischarge, there was a higher proportion of patients in the night-time surgical group with unfavorable neurological outcome (Glasgow Outcome Score 1 to 3) at both these times. There were differences in hospital length of stay, location of postoperative management (postanesthesia care unit or intensive care unit), midline shift, baseline Glasgow Coma Scale score, and acuity of surgery between the 2 groups. Logistic regression analysis showed that age, baseline Glasgow Coma Scale score, surgery acuity status, procedure type, and intraoperative complications influenced neurological outcome.Conclusions:This study found no difference in the rate of unfavorable neurological outcome in patients undergoing emergent neurosurgical procedures during the daytime and night-time. However, our findings cannot exclude the possibility of an association between timing of surgery and outcome given its limitations, including small sample size and omission of potentially confounding variables. Further well-designed prospective trials are warranted to confirm our findings.
Language Monitoring in Brain Surgery Under General Anesthesia
Authors: Martin Jennifer , Tyrand Rémi , Lopez Ursula , Bernasconi Pertusio Françoise , Lysakowski Christopher , Laganaro Marina , Schaller Karl , Boëx Colette 
Published: May 2019

Background:
Awake surgeries for cerebral lesion resection have several limitations including patient fear, discomfort, or pain. This study aimed to determine whether components of language function could be measured under general anesthesia. In this study, the occurrence of mismatch negativity (MMN) was searched in evoked potentials for phonological sounds.

Materials and Methods:
Five normal hearing, French native speaker, awake volunteers participated in evaluating the phonological task (4 females and 1 male). Eleven normal-hearing, French native speaker patients (6 left and 5 right hemisphere lesions) participated at the time of their tumor neurosurgery (3 females and 8 males). Repetitions of the standard syllable /pa/ with the insertion of 1 deviant /po/ were presented through earphones. The difference between averaged epochs of standards and deviants syllables determined the MMN. During surgery, total intravenous anesthesia was performed with propofol and synthetic opioid sufentanil. The bispectral index was targeted (40 to 60).

Results:
The MMN was found in all awake volunteers and validated by an N250 component. In the patient group, the electroencephalogram analysis was not possible in 4 of 11 patients because of anesthesia being too deep, burst suppression, or a high level of noise (>40 μV). Significant N250 response was obtained in 5 of 7 (71.4%) patients under general anesthesia. The 2 other patients also showed MMN which did not reach significance.

Conclusions:
To our knowledge, this is the first demonstration that phonological processing can be measured during brain surgery under general anesthesia, suggesting that some language processing persists under the condition of unconsciousness. These results encourage further study of language processing under general anesthesia with the goal of making intraoperative neuromonitoring.
Outcomes of a Nontraditional Dual Incision Approach for Lisfranc Trauma, Fractures, and Osteoarthritis
Authors: Blazek Cody D. , Patel Neil , Burns Patrick R. 
Published: May 2019

Background:
Numerous surgical approaches and treatments for Lisfranc pathology have been described and vary across physicians and surgical specialties. Many incisions to access the tarsometatarsal (TMT) joint complex have been described including single and dual longitudinal as well as transverse. The aim of this study was to retrospectively review and compare complication and fusion rates in patients with a Lisfranc open reduction and internal fixation or arthrodesis utilizing a nontraditional dual incision approach. Incisions were performed dorsal medial to the first TMT and dorsal along the second interspace just medial to the third TMT.

Materials and Methods:
The medical records of 1 foot and ankle surgeon were reviewed of patients who underwent Lisfranc surgery utilizing a dual incision approach for both elective and traumatic procedures. The study period encompassed January 2006 through December 2016. Statistical analysis was performed using information collected from chart-review as well as radiograph evaluation to examine predictors of complications and fusion rates.

Results:
Sixty-eight patients reviewed had the nontraditional dual dorsal incisions, 61 with TMT fusions for arthritis or injury, and 7 open reduction and internal fixation for TMT injuries. In total, 180 joint fusions were performed on the first, second, or third TMTs during arthrodesis. Four of 68 patients were revisions of previously failed fusions. All 68 patients (100%) healed soft tissue without complication. Of the 180 joints that underwent arthrodesis 170 (94.4%) fused successfully. Hardware removal occurred in 10 patients (14.7%) due to discomfort.

Conclusions:
This nontraditional dual incision dorsal approach for Lisfranc surgery has a low wound healing complication rate, in fact none were reported in this sample size of 68 patients. This approach is reproducible for either traumatic or elective procedures of the Lisfranc complex allowing excellent visualization of the medial and central tarsometatarsal joints while removing risk to the neurovascular structures inherent in the more traditional incisions.

Level of Evidence:
Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Untangling Infusion Confusion: A Comparative Evaluation of Interventions in a Simulated Intensive Care Setting
Authors: Pinkney Sonia J. , Fan Mark , Koczmara Christine , Trbovich Patricia L. 
Published: May 2019

Objectives:
Assess interventions’ impact on preventing IV infusion identification and disconnection mix-ups.

Design:
Experimental study with repeated measures design.

Setting:
High fidelity simulated adult ICU.

Subjects:
Forty critical care nurses.

Interventions:
Participants had to correctly identify infusions and disconnect an infusion in four different conditions: baseline (current practice); line labels/organizers; smart pump; and light-linking system.

Measurements and Main Results:
Participants identified infusions with significantly fewer errors when using line labels/organizers (0; 0%) than in the baseline (12; 7.7%) and smart pump conditions (10; 6.4%) (p < 0.01). The light-linking system did not significantly affect identification errors (5; 3.2%) compared with the other conditions. Participants were significantly faster identifying infusions when using line labels/organizers (0:31) than in the baseline (1:20), smart pump (1:29), and light-linking (1:22) conditions (p < 0.001). When disconnecting an infusion, there was no significant difference in errors between conditions, but participants were significantly slower when using the smart pump than all other conditions (p < 0.001).

Conclusions:
The results suggest that line labels/organizers may increase infusion identification accuracy and efficiency.
Complete Pocket Resection with Regional Flap Closure for Treatment of Cardiac Implantable Device Infections
Authors: Hansalia Riple , Rose Michael I. , Martins Catarina P. , Rossi Kristie 
Published: May 2019

Background:
Cardiac implantable electronic device infections are associated with substantial morbidity and mortality. There are varied recommendations in the literature about treatment of the wound after extraction of all hardware, but only conservative, time-consuming approaches such as open packing and negative-pressure therapy along with a long interval before reimplanting any hardware have generally been recommended for the treatment.
1–4

Methods:
A retrospective review was performed of 42 patients treated at Jersey Shore University Medical Center for implantable cardioverter defibrillator and permanent pacemaker infections between July 2010 and April 2018 with an aggressive, multidisciplinary approach utilizing an invasive cardiologist and a plastic surgeon. Clinical and demographic data were collected, and a descriptive analysis was conducted.

Results:
A total of 42 patients, with a median age of 76 years, were selected for our treatment of pacemaker pocket infection. Patients underwent removal of all hardware followed by debridement and flap closure of the wound soon after extraction. Reimplantation was performed when indicated typically within a week after initial extraction and typically on the contralateral side. There were no reports of reinfection and no mortality in all 42 patients treated.

Conclusion:
We found that the aggressive removal of all hardware and excisional debridement of the entire capsule followed by flap coverage and closure of the wound allowed for a shortened interval to reimplantation with no ipsilateral or contralateral infections during the follow-up period.
Polytrauma Transitional Rehabilitation in the Veterans Administration: Implementing the Principles of Person-Centered, Participation-Oriented Rehabilitation
Authors: Malec James F. 
Published: May 2019

Objective:
To review principles of person-centered, participation-oriented (PCPO) rehabilitation and introduce their implementation in Veterans Administration (VA) Polytrauma Transitional Rehabilitation Programs (PTRPs).

Background:
Post–hospital rehabilitation for individuals with acquired brain injury (ABI) has evolved toward PCPO rehabilitation, an approach that makes participation goals identified by the person served and his or her significant others the primary focus of rehabilitation. Goals to reduce impairments and increase activities contribute to the achievement of primary participation goals. Research, primarily in the nonveteran population, confirms the effectiveness of PCPO rehabilitation.

Overview:
In the civilian sector, PCPO programs are generally provided locally or regionally in outpatient or community settings to individuals with moderate-severe ABI associated with other traumatic injuries and comorbidities. Because of the geographical dispersion of veterans, the VA provides these services in residential centers serving larger geographical areas. The group of veterans served more often has sustained milder traumatic ABI associated with neuropsychiatric comorbidities, particularly posttraumatic stress disorder and depression. Measuring progress and outcome is important to establish a feedback loop for process improvement. VA PTRPs use state-of-the-science standardized outcome measures and methods for identifying successful cases, that is, the minimal clinically important difference. Vocational reintegration is an important element of PCPO rehabilitation. Articles in this special section detail the development and effectiveness of PTRPs.
Oxidative Stress and Genotoxicity in Pterygium: A Systemic Investigation
Authors: Kilic-Toprak Emine , Toprak Ibrahim , Caliskan Sadettin , Ozdemir Yasin , Demirtas Onder , Altintas Fatih , Kucukatay Vural 
Published: May 2019

Objectives:
To perform a systemic investigation on oxidative stress and DNA damage in patients with primary pterygium.

Methods:
This prospective cross-sectional study included 32 patients with primary pterygium (60.1±2.0 years of age) and 33 age- and sex-matched (58.8±2.2 years of age) control subjects (P>0.05). A commercial kit was used for measuring serum total oxidant status (TOS) and total antioxidant status (TAS). The comet assay was performed after lymphocyte isolation from venous blood to quantitate DNA damage. Tail length (TL), tail intensity (TI), and tail moment (TM) were used for statistical analysis as parameters of DNA damage.

Results:
In the pterygium group, TOS and TAS were significantly higher when compared with those of the control group (P=0.019 and P=0.005, respectively). In terms of DNA damage, patients with pterygium had higher TL, TI, and TM than in the control subjects (P<0.0001 for all).

Conclusions:
Although current literature focuses on local factors in pterygium pathogenesis, patients with pterygium seem to have increased systemic oxidative status (and compensatory antioxidant response) and genotoxicity, which might create a predisposition for pterygium development.