bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Knowledge and Comfort of Urban Obstetricians and Gynecologists In Taking Patient Sexual Histories [11M]
Authors: Kon Maria , Brustman Lois , Ganz Eric 
Published: April 2018

INTRODUCTION:
Public awareness of sexual-orientation and gender-identity diversity has grown, yet studies show that physicians are not comfortable taking complete sexual histories, which would address this diversity in behaviors, to benefit the physical and mental health of their patients. Medical schools and residency programs provide insufficient preparation. The objective of this study was to raise the physician participants’ awareness and gauge their interest in additional education.

METHODS:
We conducted an anonymous online survey among New York City (NYC) resident and attending obstetrician-gynecologists (OB/GYN’s). Likert items were used to gauge comfort levels in discussing sexual behavior generally, and regarding specific acts. Chi-square and Fisher-exact tests were used in the analysis.

RESULTS:
92 OB/GYN’s responded to the survey. 19 of 92 (20.6%) were uncomfortable or only somewhat comfortable discussing general sexual behavior with patients. Responder’s gender did not affect the distribution of responses. Physicians with more training (PGY-5 and beyond) were significantly more likely to be comfortable discussing masturbation and sex toys (22/34 vs 22/52, P=.042); libido and dyspareunia (35/35 vs 36/52, P=.0003), and sexual activity of elderly patients (31/34 vs 35/52, P=.01). 72 of 88 respondents (81.8%) wanted to learn more about the topic. 83 of 88 respondents (94.3%) would appreciate further education.

CONCLUSION:
This survey demonstrated the need for more formal education on sexual behavior, sexual health, and especially, alternative lifestyles, for both newly trained and experienced gynecologists. We hope to promote curriculum changes at Mount Sinai St. Luke’s and Mount Sinai West, for the diverse patient population in NYC.
Resident Advocate Development Program: Feasibility of a Novel Advocacy Curriculum in Obstetrics and Gynecology [12M]
Authors: Aksel Sarp 
Published: April 2018

INTRODUCTION:
Lawmakers across the United States are increasingly passing legislation that interferes with the patient-physician relationship and ignores physician voices. Residents must learn to critically assess healthcare policy and develop the skills necessary to advocate for their patients and their specialty. Despite the Council on Resident Education in Obstetrics and Gynecology’s inclusion of advocacy as an educational objective, no longitudinal, comprehensive curriculum on advocacy education exists in obstetrics and gynecology residencies. The Resident Advocate Development (RAD) Program was developed as a comprehensive, multi-faceted resident education program, integrating didactics, peer-reviewed articles, skills-building workshops, and legislative lobby days. The purpose of this study is to evaluate feasibility of and resident satisfaction with a novel advocacy training curriculum.

METHODS:
Obstetrics and gynecology residents at Montefiore Medical Center were recruited for participation in the pilot program between January 2017 and June 2017. Qualitative interviews were conducted with program participants at the end of the pilot program to gain insight into the curriculum’s perceived importance, strengths, and weaknesses.

RESULTS:
Nine residents participated in the pilot program. In-person interviews with each demonstrated high levels of satisfaction with didactics, skills-building workshops, and participation in legislative lobby days. Notable areas for improvement included increasing acceptance of advocacy as a resident responsibility and use of legislative visit simulations.

CONCLUSION:
This feasibility study demonstrates how a residency advocacy curriculum can be developed, implemented, and evaluated with promising results, including high participant satisfaction.
Assessing Screening Process at Wesley Women’s Clinic to Improve HPV Vaccination [15M]
Authors: Woods Maggie , Markham Claire , Duong Jennifer , Kuhlmann Zachary 
Published: April 2018

INTRODUCTION:
The lifetime cumulative risk of developing a human papilloma virus (HPV) infection is at least 80%. HPV infection has been shown to cause cervical cell abnormalities that serve as precursors to dysplasia and cancerous changes. This project aimed to evaluate the HPV vaccination screening process at Wesley Women’s Clinic (WWC) in order to increase the number of patients who are offered the HPV vaccine.

METHODS:
We retrospectively reviewed well-woman visits and postpartum visits at WWC for women ages 20-26 from January through February 2017. Only non-immune patients (have not received any HPV vaccination) were included. Cases were assessed to determine whether clinicians discussed the HPV immunization, recommended the HPV vaccination, and whether it was administered.

RESULTS:
Of 48 patients reviewed, 36 were included. The majority of the patients (52.8%, n=19) were seen for a postpartum visit, and mean age was 22.9±2.14 years old (range: 20-26). Eight (22.2%) patients had the HPV vaccination discussed at their appointment. Six (16.7%) patients were offered vaccination. Two (5.6%) patients declined the vaccine before the physician offered vaccination. Four (11.1%) patients received a HPV vaccination dose. When vaccination was discussed, it was not administered to 50% (4/8) of patients due to inability to afford the vaccine and patient refusal.

CONCLUSION:
HPV vaccination is poor due to lack of physician discussion at routine health maintenance visits and patient refusal. Steps to improve HPV vaccination rates include modifying the electronic medical record to include a vaccination history on the postpartum visit template, and creating a well-woman exam visit template.
Upstream Care: Examining Preconception Diabetes Education Among At-Risk Adolescent Women in an Academic Setting [14M]
Authors: Boevers Emily , Andrews Janet , Syrop Craig 
Published: April 2018

INTRODUCTION:
Diabetes mellitus (DM) in pregnancy produces adverse outcomes with significant human and economic costs. Potential lifetime cost savings of preventative preconception counseling for women with diabetes may reach $4.3 billion (U.S.) (Peterson et al, 2015). What opportunity exists to impact glycemic control before, and during, pregnancy by effective preconception diabetes education for adolescent women? This study assessed the current extent of preconception DM-related reproductive risk education to better inform the opportunity for an intervention.

METHODS:
We reviewed the electronic medical records (EMR) of females (N=70), ages 16-19, seen in the Pediatric Endocrinology clinic (2013-2016) and diagnosed with type 1 DM, type 2 DM, or insulin resistance. Any reproductive risks education documentation by providers, nursing or educators within Pediatric Endocrinology, or within consults to Nutrition or Obstetrics and Gynecology was accepted.

RESULTS:
According to EMR documentation, patient education for non-reproductive medical needs and complications of DM were consistently present in this population: 95.7% of patients received general education with at least 4/8 components. However, documented education regarding DM reproductive risks occurred for only 18.5% of the same patients while contraceptive use discussion occurred for 20%.

CONCLUSION:
The potential benefits of upstream, or preconception, education may include achieving recommended glucose control preceding and during pregnancy with fewer downstream maternal and fetal adverse outcomes. Although limited by the single site, retrospective design and the unknown rate of reproductive education documentation failure, our findings reveal a performance gap of potential downstream medical significance. Recognizing this deficiency provides an opportunity for a population-based intervention to improve health outcomes.
Provider-Patient Communication of Personal Breast Cancer Risk (BCR): Providers’ Beliefs [18M]
Authors: Abittan Baruch , Herman Sarah , Herman Jonathan 
Published: April 2018

INTRODUCTION:
A woman’s understanding of her own breast cancer risk (BCR) is an important precursor for care. Patients rely on their providers for accurate information and advice. The objective of this study was to understand the beliefs, practices and perceptions of providers in the primary female healthcare field, considering three areas: communication of mammography results, discussion of BCR with patients, and calculation of BCR for patients.

METHODS:
An online questionnaire consisting of 47 questions was administered between July and September of 2013 to Long Island-based women’s health providers. Participants (N=174) consisted of 88 physicians (51%), 44 obstetric and gynecology resident physicians (25%), 29 midwives (17%), 7 nurse practitioners (4%), and 6 physician assistants (3%).

RESULTS:
82% of providers agree that it is important to convey mammography results to their patients. 79% believe that it is important to discuss personal BCR with one’s patient, but only 40% feel that it is important to calculate a patient's BCR. 14% of providers reported that they actually calculate personal BCR at every well visit, and an additional 19% report calculating personal BCR if prompted by the patient. 57% admit to not calculating personal BCR for their patients. 51% of providers report that they actually discuss personal BCR at every well visit, and another 30% discuss BCR if prompted by their patient. 9% of practitioners report that they do not discuss personal BCR.

CONCLUSION:
Understanding of providers’ beliefs and practices is an initial step in improving communication of personal breast cancer risk between provider and patient.
Effects of Adverse Childhood Experiences on Female Sexual Quality of Life [22M]
Authors: Mae Delara Rykoff Ritchie , Cottrell Connie , Savitski Jennifer 
Published: April 2018

INTRODUCTION:
Sexual quality of life serves a prominent role in overall patient health and well-being. Adverse childhood events have been shown to not only factor into the development of chronic disease such as ischemic heart disease and cancer but to also negatively impact sexual health. Our study sought to determine the association between reported adverse childhood experiences and female sexual quality of life.

METHODS:
This is a cross-sectional survey study that included 100 women seeking care at a Cleveland Clinic Akron General obstetrical and/or gynecologic office in Akron, Ohio. Two validated surveys, Adverse Childhood Experiences (ACE) and Sexual Quality of Life-Female (SQOL-F), were distributed to women age 18 and older. SQOL-F questionnaire items were organized into four sub-scales: psychosexual feelings, sexual and relationship satisfaction, self-worthlessness, and sexual repression. Spearman’s rank correlation was employed to determine the relationship between ACE scores and overall sexual quality of life and the four SQOL-F sub-scales.

RESULTS:
There was no significant correlation between ACE score and overall sexual quality of life. An increasing ACE score was significantly correlated to feelings of self-worthlessness and poor psychosexual feelings (p = 0.01).

CONCLUSION:
Data indicated that adverse childhood experiences do not play a role in the overall sexual quality of life for women however instead may influence self-confidence and personal perceptions towards sexual experiences. Primary care physicians should consider screening for adverse childhood experiences and possibly suggesting psychological interventions to improve patient perception of self and in turn improve sexual quality of life.
The Impact of Obstetric Mental Health Services on Delivery Location [25M]
Authors: Nguyen Diem-Tran , Valji Farida , Prescott Jessica E. , Ihenacho Ugonna , Sobrinho Giovanna , Dossett Emily C. 
Published: April 2018

INTRODUCTION:
Women who receive prenatal care at our urban, safety-net hospital frequently deliver at outside hospitals. For perinatal women with mental illness, lack of continuity is problematic. We assessed whether participation in Obstetric Mental Health services (OBMH), a program integrating mental health services with prenatal care, is associated with increased delivery rates at our medical center compared to outside hospitals.

METHODS:
Referrals to OBMH between July 2014 and October 2016 were retrospectively identified. Prenatal care and OBMH adherence were defined per ACOG guidelines and attending at least two OBMH appointments respectively. An exploratory analysis defined OBMH adherence as five or more appointments. The association of OBMH and prenatal care adherence to delivery location was determined with chi-squared tests. Stratified analysis based on prenatal care adherence was used to determine the relative contribution of OBMH.

RESULTS:
A total of 138 pregnant patients with live births were identified. Seventy were adherent to prenatal care, 76 were adherent to 2 OBMH appointments, and 100 delivered at our hospital. Adherence to prenatal care, OBMH, and to both were each associated with delivery at our hospital (P<0.0001, P=0.0232, and P<0.0001 respectively). After stratification by prenatal care adherence, OBMH adherence was not associated with delivery location. More stringent OBMH adherence was associated with delivery location (P=0.0261), but not after adjustment for multiple comparisons.

CONCLUSION:
Prenatal care and OBMH adherence are associated with delivery location. Fewer OBMH appointments did not independently contribute to delivery at our hospital, and more appointments - suggesting greater engagement with care - may contribute.
Assessing Barriers to Cervical Cancer Screening in a Rural Nicaraguan Community [26M]
Authors: Pargas Anaisy , Wood Nicole , Romero Stephanie 
Published: April 2018

INTRODUCTION:
Cervical cancer is the leading cause of cancer-related deaths in Nicaragua - an estimated 18.43 deaths per 100,000 females in 2011. Access to health care is difficult in many Latin American countries due to educational, socioeconomic, and cultural barriers. The objective of this study was to identify specific barriers to screening adherence in a rural Nicaraguan community through qualitative measures in an effort to create a protocol to address them.

METHODS:
Through a community health initiative, eligible women (n=40) were invited to attend small group sessions hosted by local community leaders (n=11). Sessions were private to encourage candid conversation amongst participants. Data collected through questionnaires and structured discussion. All discussion topics were archived by researchers and coded for categories for qualitative analysis.

RESULTS:
Participants identified multiple barriers to effective cervical cancer prevention in their community based on personal experience. Qualitative data was assigned to categories to develop the following themes: 1-Education barriers - poor health literacy, 2-Financial or physical barriers - Travel and clinic availability, 3-Familial, marital, religious barriers - community stigma, and 4-Fear of diagnosis or cancer. All participants agreed on the need to prevent cervical cancer and increase awareness in their community.

CONCLUSION:
Our findings suggest that barriers to adequate cervical cancer prevention encompass several aspects of daily living for women in rural Nicaragua. Addressing these barriers to facilitate solutions may make the difference between life and death for these women. Additional studies will use identified themes for further survey development and program improvement to enhance cervical cancer prevention in this community.
Risk Screening for Hereditary Cancer During Obstetrical Care: Barriers to Testing and Health Disparities [27M]
Authors: Lua Lannah L. , Jackson David , Foggia Megan , Rosenbaum Amy 
Published: April 2018

INTRODUCTION:
Hereditary cancer screening performed during routine prenatal care may identify mutation positive women years before disease progression. Our primary goal was to quantify the acceptance and efficacy of a focused cancer screening program initiated during pregnancy intake. Our secondary goal was to determine if at-risk patients who accept gene testing have barriers to obtaining mutation screening.

METHODS:
In this prospective study, a self-administered cancer history questionnaire was obtained at the first prenatal visit in three urban clinics from February 2015 to April 2016. National Comprehensive Cancer Network criteria identified patients for additional information regarding BRCA or Lynch mutation testing. Patients at increased risk received immediate physician counseling and were also offered genetic counseling. Desire for mutation screening and barriers to completing genetic testing were quantified.

RESULTS:
There were 942 patients screened. The at-risk prevalence was 11.4% (n=107/942). Acceptance for gene testing was 33.6% (n=36/107). Mean age of at-risk/criteria-positive patients was 27.9 +/- 6.8 years (range 15-43). Among at-risk patients, 33.6% were Non-Hispanic White, 29.0% were Hispanic, and 27.1% were African American. Financial barriers, insurance denials, and poor access to genetic counselors limited testing to less than 5% of those who requested it.

CONCLUSION:
Obstetrical consultation is a potential “teachable moment” in hereditary cancer screening. A health disparity exists when patients cannot obtain the desired testing due to financial limitations. Future studies should be structured to remove financial barriers to genetic counseling and mutation testing. If successful, the paradigm of screening during obstetrical care could potentially identify at-risk women decades before disease development.
Satisfaction with Subsequent Delivery Route Among Women Following Obstetric Anal Sphincter Injury [38M]
Authors: Edwards Madeline G. , Suresh Shriya , Kobernik Emily , Fenner Dee , Swenson Carolyn W. 
Published: April 2018

INTRODUCTION:
We sought to assess women’s satisfaction with delivery route of their subsequent delivery following one with an obstetric anal sphincter injury (OASIS).

METHODS:
A survey study was conducted from July to September 2017 among women seen in a specialty postpartum perineal clinic at a tertiary teaching hospital following a vaginal delivery with an OASIS and who had a subsequent delivery from March 2012 to December 2016. Women were mailed a 13-item questionnaire addressing counseling after their OASIS and satisfaction with route of subsequent delivery. Satisfaction was assessed with a modified Decision Regret Scale. Bivariate analyses were used to compare women who were and were not satisfied with route of subsequent delivery.

RESULTS:
Among 115 eligible women, 43 completed the survey. The majority (n=35, 81.4%) had a subsequent vaginal delivery, and 8 (18.6%) had a subsequent cesarean delivery. 34.9% (n=15) reported the counseling they received after the OASIS influenced their decision regarding route of subsequent delivery. Half (48.8%, N=21) had no regret regarding their decision on subsequent delivery route while 16 (36%) had mild, and 6 (14%) had moderate/severe regret. Regret was associated with age, (none: 36.2 ± 3.9 vs mild: 36.5 ± 3.3 vs moderate/severe: 41.1 ± 53.4 years, p = 0.02) and with difficulty holding stool (none: 9.5% vs mild: 18.8% vs moderate/severe: 83.3%, p=.002).

CONCLUSION:
Most women with an obstetric anal sphincter injury laceration will choose a repeat vaginal delivery and half are satisfied with this decision. Age and difficulty holding stool were associated with regret regarding subsequent delivery mode.
Can Fetal Head Circumference Assessment on Ultrasound Help Predict 3rd and 4th Degree Perineal lacerations? [40M]
Authors: Ortega Marcus V. , Kim Youngwu , Masiero Jessica , Hebert Kasey , Leung Katherine , Leftwich Heidi 
Published: April 2018

INTRODUCTION:
Obstetric Anal Sphincter Injuries (OASIS) occur in 2 to 19% of vaginal deliveries in the United States. Neonatal measurements such as birthweight above 4000g or neonatal head circumference above 37cm are known risk factors for 3rd and 4th degree perineal laceration. Unfortunately, these predictors are identified after the delivery and therefore have very limited practical impact. We hypothesized that fetal Head Circumference (HC) size assessed by ultrasound in pregnancy can aid in predicting Obstetric Anal Sphincter Injuries (OASIS).

METHODS:
Secondary analysis of a retrospective cohort study assessing pregnancies with OASIS between 2005 and 2016. Inclusion criteria for this secondary analysis were third trimester ultrasound head circumference measurements. Antenatal ultrasound Head Circumference (HC) assessment, maternal demographics and labor and delivery data were documented and compared. P less than .05 was considered statistically significant.

RESULTS:
Of 2057 patients that had head circumference assessment, 121 (5.8%) had OASIS. In the unadjusted continuous analysis of the head circumference, an increase of 10% in the HC were associated with OASIS OR 1.12 (1.02-1.23) p=0.015. Although not statistically significant HC above the 90% appears to be associated with OASIS OR 3.37 (0.89-12.74) p=0.073.

CONCLUSION:
In our cohort, fetal head circumference percentile is associated with OASIS, specifically the larger the head circumference percentile, the greater the risk. Severe perineal lacerations significantly impact short and long term health outcomes such as perineal pain, dyspareunia, urinary and fecal incontinence. This piece of information might help clinicians antenatally during counseling of patients about the risk of OASIS and future implications of the injury.
Knowledge of Maternal to Child Transmission and Barriers to ART Adherence among HIV Positive Pregnant Women [3N]
Authors: Zahedi-Spung Leilah , Young Marisa , Haddad Lisa , Badell Martina 
Published: April 2018

INTRODUCTION:
Although rare, perinatal HIV transmission still occurs in the United States and most transmissions are preventable. We aim to identify patient barriers to antiretroviral therapy (ART) adherence during pregnancy and assess patient understanding of maternal-to-child transmission (MTCT).

METHODS:
This cross-sectional survey recruited HIV positive postpartum women at Grady Memorial Hospital in Atlanta between January 2016 and July 2017. Survey questions included demographic characteristics, HIV history, knowledge of MTCT and ART adherence. Perinatal and HIV outcomes were assessed using chart abstraction. Results are descriptive.

RESULTS:
Of 52 HIV positive women during the study period, 32 were eligible and consented to participation. Participating women were aged 18 to 40 years, 97% were African American, and 68% had ≥3 pregnancies. Five women had acquired HIV congenitally. Seven women (22%) had a detectable viral load at the time of delivery and three of these reported taking ART few days per week. Eleven women received intrapartum AZT. There were no cases of perinatal HIV. Only 75% of participants reported daily ART adherence and the most frequent reason for missing pills was forgetting (61%). Approximately 1/4 of women either did not know or believed a vaginal delivery, regardless of viral load, would increase their risk of MTCT.

CONCLUSION:
One quarter of women were not compliant with daily ART during pregnancy. Detectable viral load at delivery is the greatest risk factor for transmission, therefore strategies to address ART adherence are needed. Additionally, persistent misunderstanding exists regarding risk of vaginal delivery with maternal HIV.