bluuebunny/crossref_metadata_2025_split huggingface dataset:
Is Screening for Uterine Cancers an Opportunity to Reduce Cancer's Burden Among Populations With Disparities? [40G]
Authors: Del Priore Giuseppe , Khozaim Kareem Hamed , Chen Yi-Ju , Timoteo-Liaina Ianeta , Matthews Roland P.W. , Buenconsejo Lee 
Published: May 2019

INTRODUCTION:
We sought to compare cancers currently screened for and uterine cancers (UC) due to its relative ascendancy in incidence, using a vanguard of contemporary cancer risk with high non-communicable disease rates (American Samoa [AS]), as a demonstration project in a population with disparities.

METHODS:
Public access de-identified databases covering the entire national population of AS over several time periods.

RESULTS:
The annualized incidence of UC increased from 21/100,000 women/year (2004) to 50 (2011) to 60 (2015) and eclipsed breast, colon, and skin since 2011. Gynecologic cancers were the leading cause of cancer death among women after lung since approximately 2014. UC was the leading cause of gynecologic deaths (1.6x greater than ovarian or cervical) and was 33% more likely to be diagnosed than breast cancer, 3.8x greater than colon, 4.6x cervical, 7.7x ovarian, and 23x lung. Compared to mainland incidence, uterine was 2.3x and cervical 1.5x greater on AS. In a recent 24-month period, there were 33 UCs among 291 biopsies for abnormal bleeding (PPV 33/291 11.3%). The median age was 55 with 25% <50 years old; BMI-38.2 with 95% > 30; and 33.3% grade 3.

CONCLUSION:
This may be the first report of UC being the leading cause of cancer death in any population. UC has similar characteristics to currently screened cancers with an incidence in this high-risk population just under breast and prostate, but ahead of lung and colon. An enriched population, eg, BMI combined with age, especially with disparities, could benefit most from changes in screening strategy and management.
Difficulty of Intrauterine Contraceptive Insertion in Relation to Menstrual Cycle Day of Insertion [3H]
Authors: Baer Samantha , Roncari Danielle Marie 
Published: May 2019

INTRODUCTION:
The November 2017 American College of Obstetricians and Gynecologists (ACOG) Practice Bulletin No. 186 states that an intrauterine contraceptive (IUC) can be inserted “at any time during the menstrual cycle as long as pregnancy may be reasonably excluded”. However, many providers insert IUCs during menstruation to ensure that a woman is not pregnant and because of a belief that this timing leads to easier insertions. A delay in insertion may be an obstacle to access. This study aims to evaluate if menstruation decreases the rate of difficult insertions.

METHODS:
We conducted a retrospective chart review of 250 women with IUC insertions in our Gynecology outpatient clinic within 5 days of the start of last menstrual period (LMP) compared to women with insertion outside of menses. Difficult insertions were defined as an initial failed attempt at placement, need for additional dilation, need for pharmacologic cervical preparation, need for second provider, or need for ultrasound guidance.

RESULTS:
IUCs were inserted within 5 days of LMP in 18.8% of patients (n = 47). The overall difficult insertion rate was 10.0% (n = 25) with 4 failed placements (1.6%). For insertions within 5 days of LMP, 17.0% were difficult compared to 8.4% for insertions not within 5 days of LMP.

CONCLUSION:
Our results indicate that IUC insertion within 5 days of LMP is not associated with a higher rate of difficult placements. Changing practice patterns to encourage interval IUC insertion would decrease the barrier of timing for women seeking a long-acting form of contraception.
Discontinuation of Levonorgestrel Intrauterine System (LNGIUS) Versus Low Dose LNGIUS (LD-LNGIUS) [4H]
Authors: Cope Adela G. , Weaver Amy , Casey Petra 
Published: May 2019

INTRODUCTION:
Rates of long acting reversible contraception (LARC) use, including LNGIUS and LD-LNGIUS the United States are increasing. The aim of this study was to compare rates of and reasons for discontinuation of these two LARC.

METHODS:
Following IRB approval, premenopausal women 13-55 years old undergoing LD-LNGIUS (13.5 mg) insertion for contraception at Mayo Clinic Rochester from 1/1/2013 to 12/31/2015 were identified (n=82). A random sample of 328 women meeting the same criteria with LNGIUS insertion was identified. The cumulative incidence of discontinuation for symptom-related complaints was compared between groups after taking into account discontinuation for other reasons as a competing risk.

RESULTS:
Compared to those with LNGIUS, women with LD-LNGIUS were younger (mean age, 25.9 vs. 30.3 years), more likely to be nulliparous (86.6% vs. 28.0%), less likely to have previously used LARC (13.4% vs. 35.1%), and had lower BMI (mean, 25.2 vs. 27.0 kg/m2). In women with subsequent follow-up, 57.3% (43/75) of the women with LD-LNGIUS expressed a symptom concern compared to 60.9% (171/281) of the women with LNGIUS. The cumulative incidence of discontinuation for symptom-related complaints by 2 years was higher in the LD-LNGIUS group, with rates of 20.0% vs. 13.8% based on patients with follow-up and 23.4% vs.12.8% based on a subset of 58+58 women matched on age, race, gravidity, and insertion year.

CONCLUSION:
Women with LD-LNGIUS are less likely to express symptom concerns than women with LNGIUS, but more likely to discontinue for symptom-related complaints. These findings may inform counseling of women with hormonal intrauterine contraception placement.
Effects of Immediate Postpartum Long-Acting Reversible Contraception on Short Interpregnancy Intervals [7H]
Authors: Wu Min , Eisenberg Ruth , Negassa Abdissa , Levi Erika 
Published: May 2019

INTRODUCTION:
Short interpregnancy interval (IPI) pregnancies, defined as a pregnancy conceived within 18 months of a prior delivery, are associated with adverse maternal and fetal outcomes. Given the well-established efficacy of long-acting reversible contraceptives (LARC) in decreasing unintended pregnancy, the provision of immediate postpartum LARC offers an excellent opportunity to increase access to highly-effective contraception and optimize interpregnancy intervals. We aim to evaluate the effect of immediate postpartum LARC on rates of short IPI pregnancy.

METHODS:
We conducted a retrospective cohort study of all women who delivered at Montefiore Medical Center between January 2015 to June 2016 (N=9,561). Using logistic regression models, we assessed the association between receiving immediate postpartum LARC and rates of short IPI delivery and short IPI pregnancy, adjusting for potential confounders. This study was approved by the Albert Einstein College of Medicine Institutional Review Board.

RESULTS:
In our cohort, 12.3% of patients received immediate postpartum LARC. The overall rate of short IPI delivery was 2.79%, and the rate of short IPI pregnancy was 12.2%. Patients who received immediate postpartum LARC were less likely to have a short IPI delivery (OR 0.20, 95% CI 0.09-0.45) or short IPI pregnancy (OR 0.44, 95% CI 0.33-0.58). These associations remained significant after adjusting for potential confounders including age, mode of delivery, socioeconomic status, and race.

CONCLUSION:
This study is the first to examine the effect of immediate postpartum LARC on short interpregnancy intervals. The findings suggest that immediate provision of postpartum LARC is a promising method of improving interpregnancy intervals.
Essure Removal via Salpingectomy With Cornual Resection vs. Total Laparoscopic Hysterectomy—A Case Series [8H]
Authors: Cho Yonghee Kristina , Kim Daniel , Harkins Gerald Joseph , Valentine Lindsey N. , Deimling Timothy Allen , Benton Andrea 
Published: May 2019

INTRODUCTION:
The Essure is most commonly removed by bilateral salpingectomy with cornual resection (BS-CR) or total laparoscopic hysterectomy with bilateral salpingectomy (TLH-BS); however, limited data exists on Essure removal. The purpose of this study is to evaluate the safety and efficacy of Essure removal via BS-CR and TLH-BS.

METHODS:
A retrospective chart review and follow-up patient survey were conducted at an academic institute of patients undergoing surgical removal of the Essure device via BS-CR or TLH-BS between 2014 and 2017.

RESULTS:
58 patients underwent Essure removal-33 via BS-CR and 25 via TLH-BS. The mean operative time for BS-CR was 61 minutes vs. 70.5 minutes for TLH-BS. All procedures had an estimated blood loss of less than 50mL. There were no intraoperative complications. Mean length of stay for BS-CR was 572.6 minutes vs. 772.4 minutes for TLH-BS. Postoperatively, 1 patient who underwent BS-CR presented to the emergency room (ER) due to subjective fevers; no pathology was identified. One TLH-BS patient was admitted with vaginal cuff cellulitis, and one presented to the ER for vaginal bleeding without cuff separation/dehiscence. Satisfaction was noted in 30/32 (93.8%) patients who underwent BS-CR vs. 20/20 (100%) who underwent TLH-BS. Improved quality of life was reported in 29/32 (90.6%) of patients who underwent BS-CR vs. 19/20 (95.0%) who underwent TLH-BS. 31/32 (96.9%) patients who underwent BS-CR reported they would undergo removal again vs. 19/20 (95.0%) who underwent TLH-BS.

CONCLUSION:
Bilateral salpingectomy with cornual resection and TLH-BS are likely comparable methods for Essure removal, with overall high satisfaction.
An Interprofessional Approach to Training in Cervical Cancer Screening in a Low Resource Setting of Rural Haiti [12H]
Authors: Mansour Trina , Tustison Kimberly , Debay Marc , Tran Mai Linh , Ngo Anh Tuan , Li Angie 
Published: May 2019

INTRODUCTION:
Cervical cancer continues to be a public health concern mostly affecting low-resource countries and has a high prevalence in Haiti, where no national prevention program exists. To address this gap, Hospital Albert Schweitzer (HAS) launched a cervical cancer screening and treatment program. The first step consisted of a two-week workshop providing didactic and supervised clinical training to healthcare professionals.

METHODS:
A US-based interprofessional team developed a comprehensive curriculum focusing on visual inspection with acetic acid, cytology-based screening, colposcopy, cryotherapy and loop electrosurgical excisional procedure. 3 Ob/Gyns, 2 general practitioners, 3 nurse-midwives and 2 nurses were trained. The course consisted of half-day didactic sessions and half-day supervised clinical practice sessions during the first week. The second week involved high-volume practice of skills. Pre-and post-tests were utilized during didactics, and clinical competency assessment were utilized at the end of each week. These tools will also be used during the 6-month follow-up evaluation.

RESULTS:
All trainees attended all didactic and clinical training sessions. They screened a total of 988 women. Based on the pre- and post-tests, trainees demonstrated an average increase of knowledge of cervical cancer screening by 9.5%. They all demonstrated satisfactory clinical competency by the end of the second week.

CONCLUSION:
Implementation of an interprofessional training event in a low-resource setting proved to be effective in teaching healthcare professionals to perform cervical cancer screening and treatment services on a clinically competent level. Results of the 6-month.
Analysis of Gender of Presenters at the 2018 ACOG Annual Clinical and Scientific Meeting [13H]
Authors: Koniares Katherine G. , Kellogg Emily , Evans Megan L. 
Published: May 2019

INTRODUCTION:
In 2017, 58.7% of practicing OB/GYNs were female and in 2016, 82.3% of OB/GYN residency matches were female. Previous studies have demonstrated that female speakers are underrepresented at medical conferences. The objective of this study was to determine if the number of female speakers at the 2018 ACOG Annual Clinical and Scientific Meeting was proportional to the number of females practicing OB/GYN.

METHODS:
All presentations in the 2018 ACOG Annual Clinical and Scientific Meeting program were included in this study. The title, topic, and type of presentation, as well as the speaker's name, degrees held by the speaker, and gender of the speaker were analyzed.

RESULTS:
There were 1021 presentations by 897 speakers. 227 speakers (25.3%) were male, 653 speakers (72.8%) were female, and gender was unknown for 17 speakers (1.9%). There were 13 types of presentations; 538/698 (77.0%) of Eposters and 22/25 (88%) of oral presentations were made by female speakers. There were 20 topics; 344/463 (74.2%) of obstetrics, 115/174 (66.7%) of gynecology, 3/3 (100%) of domestic violence, and 1/5 (20%) of “cutting-edge” presentations were made by female speakers.

CONCLUSION:
Overall, female speakers were well represented at the conference, outnumbering male speakers 3:1, which correlates with the increasing proportion of OB/GYNs. Limitations of this study include that the number of male and female conference attendees and the stage of speakers' careers (i.e. resident, fellow, or attending) were unavailable.
Correlating the Length of Medical School Clerkship and OB/GYN Specialty Selection [14H]
Authors: Shanks Anthony L. , Christman Megan Ann , Scott Nicole Parker , Fadel William , Hoffman Mark Richard 
Published: May 2019

INTRODUCTION:
Third year medical school clerkships provide students an opportunity to see specialties first hand and observe mentors in the field. Shorter clerkships have the potential to negatively affect their decision on specialty selection. We sought to describe clerkship length at US medical schools with OB/GYN clerkships and correlate this to the OB/GYN residency match rate in 2017.

METHODS:
This was an observational cohort study of US allopathic medical schools with OB/GYN clerkships. Medical school websites were reviewed and clerkship coordinators contacted when necessary to determine clerkship length. The 2017 GME Track Resident Survey was utilized to determine medical schools for first-year residents. Mean number of programs and students matching into OB/GYN were reported with standard deviations.

RESULTS:
147 US allopathic medical schools were identified and complete clerkship information was available for 137. The majority of medical schools provided a 5-6 week clerkship (n = 101; 73.7%) followed by 7-8 weeks (n = 28; 20.4%) and 4 weeks (n = 8; 5.8%). Residency Survey data was available for 94.8% of first year residents. Four-week, 5-6 week and 7-8 week clerkships were associated with a 3.96% (SD 0.88), 4.77 (SD 2.38) and 5.19 (2.21) match rate into OB/GYN respectively.

CONCLUSION:
The majority of US allopathic medical schools provide a 6-week OB/GYN clerkship experience. There was an increase in the percentage of medical students entering OB/GYN based on clerkship length that was not statistically significant. As medical schools undergo curriculum change, it is important that adequate exposure to the specialty be provided.
Does a Structured Formative Feedback System Improve Learner Perception of the Obstetrics and Gynecology Clerkship? [16H]
Authors: Edwards Allison , Sabourin Jeanelle 
Published: May 2019

INTRODUCTION:
Medical students are more likely to pursue specialty training in fields they perceived positively during their training. This can be influenced by their satisfaction with feedback during a rotation. We investigated whether a structured formative feedback system would improve learner perception of the Obstetrics and Gynecology clerkship.

METHODS:
This observational cohort study included medical students from the Class of 2017 (control cohort) and 2018 (intervention cohort). Institutional ethics board approval was obtained. A formative feedback system was implemented during Obstetrics and Gynecology rotations for the Class of 2018. It consisted of a set of electronic forms asking for strengths and requirements for improvement in the student's assessment of a patient with a particular presenting complaint. Students were invited to complete a survey about their overall rotation experience during their final year of training using Likert Scales. The primary outcome was the proportion of students who reported a positive experience during their rotation. Chi-squared analysis was used to compare the proportion of positive responses between each group.

RESULTS:
190/286 (66.4%) students responded to the survey. 72/103 (70.6%) and 65/87 (74.7%) students reported a positive experience on their rotation (good, very good or excellent) in the control and intervention cohorts, respectively (P=.5). 27/83 (31.0%) of students felt the system positively influenced the rotation.

CONCLUSION:
Implementation of this structured formative feedback system did not improve learner perception of the rotation. Further research is needed to determine if mechanisms that ensure students receive specific and actionable feedback would affect this outcome during an Obstetrics and Gynecology rotation.
Cervical Elongation Among Patients Undergoing Vaginal Hysterectomy for Prolapse Versus Other Benign Indications [22H]
Authors: Elio Zeno Aldene Olia , Takashima Yoko , Ghayouri Sara , Yazdany Tajnoos 
Published: May 2019

INTRODUCTION:
Surgeons have cited anterior colpotomy as a barrier to performing vaginal hysterectomy (VH); cervical elongation (CE) may make this difficult. This study aims to understand CE and its significance among patients undergoing VH for pelvic organ prolapse (POP) versus those undergoing VH for other benign indications.

METHODS:
VH from 2015-2017 were identified through CPT codes. Study variables were obtained from operating room and pathology reports. CE was identified according to four definitions reported in three different studies. Twenty-three patients per study arm were estimated to be necessary to detect a statistically significant difference in CL >33.8mm between VH patients with versus without POP.

RESULTS:
Chart review yielded 217 cases. Number of included VH cases was 128. There were 51 VH for POP, and 77 VH for other indications. CE prevalence was higher among patients undergoing VH for POP based on uterine corpus to cervical length ratio (UC:CL) > 0.79 (25.5% versus 15.6%) and CL > 33.8mm (66.7% versus 51.9%). Other CE parameters demonstrated no statistically significant difference between groups. In regression analysis, postmenopausal status was not associated with CL > 3.38 (OR 0.138, 95% CI 0.02-0.941); and VH not for POP were more likely to have longer-than-average operating time (mean=210).

CONCLUSION:
CE was more prevalent in patients undergoing VH for POP compared to those having VH for other indications. CE was not associated with perioperative outcomes. These results refute existing literature regarding CE, particularly that CE may not be of consequence with regards to clinical outcomes during and after VH.
Cervical Length as a Predictor of Latency Interval in Twin Pregnancies With Preterm Prelabor Rupture of Membranes [35H]
Authors: Jayesh Tigdi , Luksts Jessica , Stewart Andrew , Morais Michelle 
Published: May 2019

INTRODUCTION:
Preterm prelabor rupture of membranes (PPROM) is a significant risk factor for preterm birth, carrying medical, financial and psychological burden. Predicting onset of labor after PPROM can result in timely interventions, including appropriate transfer to tertiary care centers. Ultrasound-measured cervical length can predict preterm delivery in singleton pregnancies with PPROM, but no data exists in twins. Therefore, we sought to determine whether cervical length could predict latency interval in twin pregnancies with PPROM.

METHODS:
Using the BORN Database, we performed a retrospective study identifying 43 twin pregnancies between 2012-2016 complicated by PPROM at McMaster University, Canada. Cervical length was determined by ultrasound measurement. We then compared our primary outcome, latency to labor in those pregnancies with cervical lengths less than 25 mm to those greater than 25 mm and results were analyzed by Mann-Whitney statistical analysis. Additional secondary measures compared the groups on length of stay, PPROM parameters and neonatal outcomes.

RESULTS:
We determined that the average latency interval in those twin pregnancies with cervical lengths less than 25 mm is statistically significantly shorter than in those with cervical lengths greater than 25 mm (49.2 vs. 196.0 hours, p=0.035). The average length of stay was also significantly greater in those with longer cervical lengths (5.52 vs. 11.05 days, p=0.03). Potential confounders such as parity, chorionicity, erythromycin or magnesium sulfate did not have any significant effect by ANCOVA regression analysis.

CONCLUSION:
In those twin pregnancies complicated by PPROM, cervical lengths less than 25 mm are associated with shorter latency intervals, which may prompt critical, timely intervention in this group.
Challenges in Providing OB Services in a Rural State: An Iowa Statewide Perinatal Care Program Study [36H]
Authors: Hunter Stephen K. , Dunbar Amy , Smith Penny , Dagle John , Segar Jeffrey 
Published: May 2019

INTRODUCTION:
Over half the hospitals providing maternity services to the state of Iowa are rural Level I centers. OB services at these hospitals are closing annually at an increasing rate (21 in the last 15 years with 8 in 2018). We determined the current obstetrical provider workforce and identified reasons for the closures of these rural OB services.

METHODS:
Current OB provider workforce data were obtained by contacting all Level I hospitals via email, SurveyMonkey®'’ or telephone. Reasons for rural hospital OB service closures were identified through a six question survey mailed to the chief executive officers of all 93 Level I Iowa hospitals.

RESULTS:
46 rural level 1 hospitals provide OB services in Iowa. Only 35% have an obstetrician (OB) on staff, while 65% are staffed solely by Family Medicine (FM) physicians. Cesarean sections performed in these rural hospitals are done by FM only (5), general surgeons only (8) or a combination of FM and GS (13). Thus 56.5% of these rural hospitals have no OB on staff to perform surgical deliveries or respond to obstetrical hemorrhagic emergencies. Only 1/46 rural hospitals has an anesthesiologist on staff; 45/46 utilizes only certified registered nurse anesthetists. Primary reason for rural OB service closures was the inability to recruit or retain physicians willing or capable of providing obstetric care. Additional reasons included concerns regarding quality of obstetric care, medical-legal liability and financial concerns.

CONCLUSION:
Several issues must be addressed to avoid a decline in access to high quality maternal healthcare in rural Iowa.