bluuebunny/crossref_metadata_2025_split huggingface dataset:
Routine HbA1c Testing in Women Undergoing Major Gynecologic Surgery to Detect Prevalence of Glucose Intolerance [20Q]
Authors: Valant Roseanna , Ahamed Tarnima , Musa Fernanda , Chan Kent , Jimenez Edward , Chalas Eva 
Published: April 2018

INTRODUCTION:
Determine the prevalence of undiagnosed diabetes, prediabetes and overall incidence of glucose intolerance in women undergoing major surgical procedures on the gynecologic oncology service.

METHODS:
Retrospective review of preoperative HbA1c levels obtained at preadmission testing in women scheduled for major gynecologic surgery at NYU Winthrop Hospital by gynecologic oncologists between July 2014 and July 2016. Exclusion criteria were lack of HbA1c within 90 days of scheduled surgery and all women undergoing minor surgical procedures. Diabetes was defined either by established diagnosis or with HbA1c ≥6.5, and prediabetes if HbA1c ranged 5.7- 6.4. Value less than 5.7 was considered normal.

RESULTS:
343 women underwent major procedures and had HbA1c levels obtained. Fifty-eight (16.9%) had a known diagnosis of diabetes, and 285 (83.1%) were presumed non-diabetics. Majority (182, 63.9%) had normal HbA1c, 86 (30.2%) were prediabetic and 17 (6%) met criteria for diabetes, for a 36.2% prevalence of abnormal glucose tolerance in presumed non-diabetics. When all 343 women were considered, the diagnosis of glucose intolerance was present in 161 (46.9%), 64.0% of whom were previously undiagnosed.

CONCLUSION:
Nearly half of the women undergoing major gynecologic surgery procedures on the oncology service had impaired glucose tolerance. The diagnosis was previously not established in 64.0%. Pre-surgical assessment of HbA1c is warranted in this high risk population.
Reduction of Vaginal Cuff Dehiscence in Total Laparoscopic Hysterectomy with use of Un-barbed Monofilament Suture [5R]
Authors: Schultze Peter , Kronbach David , Brannen Laura , Mather Tara L. , Budny Tina 
Published: April 2018

INTRODUCTION:
The incidence of vaginal cuff dehiscence is higher following total laparoscopic hysterectomy (TLH) compared to vaginal and abdominal hysterectomy. Theorized factors include energy, anatomy, stitch size, and other variables. Following a rise in our dehiscence rate to above 2%, several of our surgeons switched to PDS instead of barbed suture based on clinical observations. We present the results below.

METHODS:
Vaginal cuff handling at laparoscopic hysterectomy was reconsidered. Our group performs a significant volume of relatively homogeneous TLHs. Several physicians transitioned away from a two way barbed suture closure instead using two way running #1 polydioxanone monofilament suture (#1PDS). PDS closure was performed tensioning as in abdominal or vaginal hysterectomy cuff closure. During a 6 month period the two rates of vaginal cuff separation/dehiscence following TLH were compared using the Chi-squared test.

RESULTS:
334 TLHs were included in our 6-month study. No eviscerations were noted. Separations (managed surgically or expectantly) were observed in nine out of 175 cases (9/175, 5.1%) when barbed suture was used vs zero of 159 cases when PDS suture was used (0/159, 0%, p-value .0000028).

CONCLUSION:
Etiology of observed associations of dehiscence with TLH remains unclear. Postulated solutions include optimization of amputation and cuff closure. Our data show that, in a large multispecialty gynecologic group performing high volume TLHs, dehiscence rate is reduced using PDS monofilament. Techniques employed strive to mimic abdominal hysterectomy cuff closure tension and anatomic stitch bite sizes. This study is limited by cuff closure techniques being performed by different physicians.
The Prevalence of Postnatal Depression in Women with a History of Bariatric Surgery [33R]
Authors: Kok Susan N. , Kim Sharon J. , Grothe Karen , Moore Katherine M. , Long Margaret E. , Collazo-Clavell Maria L. 
Published: April 2018

INTRODUCTION:
Obesity is associated with postnatal depression; however, the prevalence of postnatal depression in women after bariatric surgery has not been further evaluated.

METHODS:
For this observational investigation, women, ages 18-45 years, with pregnancy from 1989-2015 and bariatric surgery were identified using the Olmsted County Rochester Epidemiology Project and ICD-9 codes. Those with surgery after pregnancy and/or without permission to use their records were excluded. Charts were reviewed for maternal and infant characteristics and outcomes. Postnatal depression was identified from a positive screen, referral for mood disorder, antidepressant medication increase, suicidality, or provider diagnosis from delivery to 12 months postpartum.

RESULTS:
Ninety-one women with pregnancy >23 weeks after surgery and available data were reviewed. The average body mass index at time of surgery was 47±8.6 kg/m2 (N=88) and at time of pregnancy 32±6.6 kg/m2 (N=89). The average age at surgery was 29±4.1 years and at delivery 33±4.4 years. Roux-en-Y gastric bypass was the most common surgery (N=70, 77%). Pregnancy outcomes included: 14% preterm deliveries (<37 weeks, N=13), 67% vaginal deliveries (N=61), no stillbirths, and 97% singleton deliveries (N=88). Mean singleton birthweight was 3225 grams (±471, N=86). Postnatal depression was noted in 38% of women (N=35), which is significantly higher than that for obese women in general (13-18%) when a 1-sample proportion test is conducted for comparison (38%vs18%, p <0.0001).

CONCLUSION:
Postnatal depression may be increased in women with a history of bariatric surgery. Further investigation is needed, but particular care should be taken to screen and diagnose these high-risk women.
Patient Race/Ethnicity Are Predictors for Peripartum Hysterectomy [27J]
Authors: Ryan Isa , Martin Kimberly A. , Lawson Shari M. , Martin Kristin L. , Chou Betty 
Published: April 2018

INTRODUCTION:
The rate of peripartum hysterectomy (PH) is rising in the United States. Patient characteristics such as race and ethnicity have been identified as a predictor of other adverse perinatal outcomes such as preterm delivery and stillbirth. In order to determine possible predictors and disparities, different clinical and socio-economic characteristics were examined.

METHODS:
We conducted a retrospective cohort study of 9,082,034 women (weighted to represent over 43 million women) aged 12–55, who were hospitalized for childbirth using data from the National Inpatient Sample (2004–2014). We tested the association between patient race/ethnicity and receiving PH during the hospitalization, before and after adjustment for advanced age, year of hospitalization, socioeconomic and hospital-level factors, as well as other known clinical correlates of PH.

RESULTS:
In adjusted analyses, race/ethnicity remained a significant predictor of in-hospital PH for Black (OR=1.11; P<.05) and Hispanic (OR=1.18; P<.01) women compared to their white counterparts. Compared to women who are insured with an HMO or private insurance, women who are covered by Medicaid (OR 1.13) or are self pay (OR 1.23) were at statistically increased risk. Conversely, economic level, using zip code quartile as an indicator, was not a statistically significant predictor.

CONCLUSION:
Race/ethnicity has been found to be an independent predictor of PH, even after adjustment for clinical, socioeconomic and hospital factors. Future research should further investigate the reasons why certain women are at increased risk for receiving this high risk procedure, in order to develop and test interventions to improve peripartum outcomes.
The Association Between Antenatal Depressive Symptomatology and Postpartum Visit Attendance [38K]
Authors: Shim Jessica , Stark Elisabeth , Ross Carolyn , Miller Emily Stinnett 
Published: April 2018

INTRODUCTION:
A comprehensive postpartum visit within the first 6 weeks after birth is recommended, however attendance remains poor. We sought to evaluate whether antenatal depression was associated with postpartum visit non-attendance.

METHODS:
This retrospective cohort study included all women who received prenatal care at the academic outpatient offices associated with a single tertiary care center between January 1, 2008, and December 31, 2014. Women were screened for antenatal depression using the Patient Health Questionnaire-9, and a score of at least 10 was used to define antenatal depressive symptomatology. Attendance at the postpartum visit was compared between women with and without antenatal depressive symptomatology using bivariable and multivariable analyses.

RESULTS:
Of the 5,127 women who met inclusion criteria, 912 (18%) did not attend the postpartum visit. Women who did not attend a postpartum visit were younger and more likely to be a racial or ethnic minority, publicly insured, or multiparous; they were also more likely to have gestational diabetes, a higher body mass index, as well as a preterm delivery. In addition, women who did not attend their postpartum visit were more likely to have experienced antenatal depressive symptomatology (29% versus 19%, P<.001). This association persisted even after controlling for potential confounders.

CONCLUSION:
Antenatal depressive symptomatology is significantly associated with non-attendance at the postpartum visit. As women with antenatal depression are at high risk for ongoing postpartum depression, future research should be directed towards measures to improve postpartum visit attendance.
Integrating Screening, Brief Intervention and Referral to Treatment for Substance Abuse Into Prenatal Care [3L]
Authors: Hostage Jean Chavez , Brock Julia , Craig Wendy , Sepulveda Debra 
Published: April 2018

INTRODUCTION:
Universal screening for substance abuse during pregnancy including brief intervention and referral to treatment (SBIRT) is recommended by ACOG. Here we present the implementation of SBIRT to facilitate clinical intervention and collect data about substance abuse during prenatal care.

METHODS:
A literature-based SBIRT instrument was developed and approved by regional clinicians. An EPIC team integrated the tool into the electronic health record (EHR) and built reports to display aggregate data. SBIRT is performed by a clinical social worker in a resident clinic and at nursing intake in a separate generalist and maternal fetal medicine (MFM) practice. Data reports included substance use by parents, partners, and patient (past and present use); a positive screen was defined as a “yes” response to any question from patients screened for the first time from June 2017 to September 2017.

RESULTS:
As of September 2017, 49% and 72% of all patients were screened in the MFM and generalist practice, respectively. Forty-six percent of new patients were screened in the resident clinic. In the resident clinic, MFM, and generalist practice from June 2017 to September 2017, 43% (n=34), 41% (n=35), and 32% (n=29) screened positive, respectively. Thirty-eight percent (n=30), 10% (n=9), and 10% (n=9) reported past or present substance abuse.

CONCLUSION:
Integrating universal SBIRT into prenatal care at disparate locations using EHR requires a multi-disciplinary approach. The SBIRT tool facilitates universal, reportable substance abuse screening. The tool has been expanded to quantify use and report interventions. Future reports will characterize substance abuse in our prenatal practices and inform intervention strategies in this population.
Teaching Optimism During Pregnancy: A Possible Protective Practice Against Postpartum Depression [15L]
Authors: Strunk Miguel A. , Bachmann Gloria A. 
Published: April 2018

INTRODUCTION:
Transitioning into motherhood can render women more vulnerable to anxiety and depressive symptoms. Postpartum Depression (PPD) impacts between 10% and 26% of women worldwide. Pre-existing depression and anxiety, socioeconomic status, race, ethnicity, marital status, social relationships and support systems can be predisposing factors. Depressive outlooks also have adverse physical effects on infants that appear to increase the risk of preterm births or low birth weight, as well as negatively impact the mother's relationships. This review evaluated whether optimistic practices during pregnancy may decrease the risk of postpartum depression.

METHODS:
A literature review using standard search engines retrieved 16 scholarly articles and journals devoted to mental health and postpartum depression.

RESULTS:
Data suggest that women who exhibit optimism in the antepartum period appear to be at a decreased risk of postpartum depression. Since preliminary research suggests that optimism during pregnancy may act as coping and defense mechanisms, perhaps antepartum education should focus on teaching this practice, which may result in fewer pregnant women developing PPD. In fact, optimism educational practices may have even greater efficacy if the woman has a positive outlook before she becomes pregnant.

CONCLUSION:
Optimism, which can be enhanced through education, may play a role in contributing to an overall healthy pregnancy and the postpartum experience. Clinicians should consider teaching pregnant women, the benefits of optimism. This can have great benefits not only for women faced with the possibility of postpartum depression, but also for their babies, families, and relationships.
Current and future uses of probiotics
Authors: Tanner Georgia , Matthews Kacie , Roeder Hannah , Konopasek Maggie , Bussard Adrienne , Gregory Tanya 
Published: April 2018

ABSTRACT
The relationship between host and gut microbiota has been the topic of research in recent decades, with particular emphasis on various species of bacteria and their distinct role in health promotion. Early promising research led to the new term probiotic, coined to describe these beneficial bacteria. This early research has laid the foundation for various proposed mechanisms of probiotic effects on health. This article describes current areas of established probiotic use and introduces areas of current investigation, including psychobiotics, which may help patients suffering from psychiatric illness.
New Radiopharmaceutical Approved to Treat Rare Digestive Tract Cancer
Authors: Aschenbrenner Diane S. 
Published: April 2018

Lutathera (lutetium Lu 177 dotatate), a new iv radioactive drug, has been approved to treat gastroenteropancreatic neuroendocrine tumors.Common adverse effects of Lutathera include lymphopenia; high levels of the enzymes gamma-glutamyltransferase, alanine transaminase, and aspartate transaminase (indicators of impaired liver function); vomiting; nausea; hyperglycemia; and hypokalemia.
Urine Reagent Strips Are Inaccurate for Assessing Hypohydration: A Brief Report
Authors: Adams J.D. , Capitan-Jiménez Catalina , Huggins Robert A. , Casa Douglas J. , Mauromoustakos Andy , Kavouras Stavros A. 
Published: April 2018

Objective:
To assess the diagnostic ability of urine reagent strips to identify hypohydration based on urine specific gravity (USG).

Design:
This study examined the agreement of USG between strips and refractometry with Bland–Altman, whereas the diagnostic ability of the strips to assess hypohydration was performed by receiver operating characteristic analysis.

Setting:
Arkansas high school football preseason practice.

Participants:
Four hundred fourteen fresh urine samples were analyzed.

Main Outcome Measures:
Urine specific gravity was assessed by both reagent strips and refractometry. Cutoffs of >1.020 and >1.025 were used for identifying hypohydration.

Results:
Bland–Altman analysis showed agreement of the 2 methods. Overall diagnostic ability of the urine strip to identify hypohydration was fair (area under the curve 72%-78%). However, the sensitivity to correctly identify hypohydration was poor (63%-71%), and the specificity of correctly identifying euhydration was poor to fair (68%-83%).

Conclusion:
The urine strip method is not valid for assessing hypohydration.
Can we still learn from the Seven Countries Study?
Authors: Menotti Alessandro , Puddu Paolo Emilio 
Published: April 2018

Purpose of review
The Seven Countries Study (SCS) of Cardiovascular Diseases started midway last century and was the pioneer investigation of coronary heart disease (CHD) at international level. The 16 cohorts of middle-aged men enrolled in eight nations of seven countries allowed to show large differences of CHD incidence and mortality across different cultures, partly explained by average levels of serum cholesterol and dietary habits, that is, Western type patterns in the high-risk populations, and Mediterranean or Oriental type in Southern Europe and Japan. Later, critics to the validity of the study were largely based on fake news, wrong or distorted information uncritically transmitted in a cascade of media.

Recent findings
Recent analyses based on 45–50 years of follow-up showed and confirmed that diet patterns were associated with all-cause mortality and age at death; that multivariate coefficients of major risk factors of CHD were not heterogeneous across different populations and cultures; that analysis of competing risks of CHD versus other conditions identified serum cholesterol as the critical determinant; that true CHD manifestations had different determinants compared with Heart Diseases of Uncertain Etiology frequently confused with CHD.

Summary
The SCS can still teach investigators and scholars of cardiovascular epidemiology, if old contributions are carefully read and interpreted; it is still recognized as the seminal study in this area at international level although it had limits as any other study but represented the first step into the identification of the relationship of diet with CHD and mortality across populations, and of the Mediterranean diet.
Patient Information Needs and Breast Reconstruction After Mastectomy
Authors: Carr Tracey L. , Groot Gary , Cochran David , Holtslander Lorraine 
Published: April 2018

Background
Although many women benefit from breast reconstruction after mastectomy, several studies report women's dissatisfaction with the level of information they were provided with before reconstruction.

Objective
The present meta-synthesis examines the qualitative literature that explores women's experiences of breast reconstruction after mastectomy and highlights women's healthcare information needs.

Methods
After a comprehensive search of 6 electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, and Scopus), we followed the methodology for synthesizing qualitative research. The search produced 423 studies, which were assessed against 5 inclusion criteria. A meta-synthesis methodology was used to analyze the data through taxonomic classification and constant targeted comparison.

Results
Some 17 studies met the inclusion criteria, and findings from 16 studies were synthesized. The role of the healthcare practitioner is noted as a major influence on women's expectations, and in some instances, women did not feel adequately informed about the outcomes of surgery and the recovery process. In general, women's desire for normality and effective emotional coping shapes their information needs.

Conclusion
The information needs of women are better understood after considering women's actual experiences with breast reconstruction. It is important to inform women of the immediate outcomes of reconstruction surgery and the recovery process.

Implications for Practice
In an attempt to better address women's information needs, healthcare practitioners should discover women's initial expectations of reconstruction as a starting point in the consultation. In addition, the research revealed the importance of the nurse navigator in terms of assisting women through the recovery process.
Efficacy of Elastic Resistance Training Program for the Institutionalized Elderly
Authors: Motalebi Seyedeh Ameneh , Amirzadeh Iranagh Jamileh , Mohammadi Fatemeh , Cheong Loke Seng 
Published: April 2018

Objective:
This study aimed to assess the efficacy of a progressive resistance training program on dynamic balance and functional mobility among the institutionalized elderly.

Methods:
A total of 45 institutionalized elderly from a senior welfare home participated in this quasi-experimental study. The exercise group (n = 21) attended a group-based program for 12 weeks, meeting twice a week. A 2-factor repeated-measures analysis of variance and independent and paired t tests were used to analyze the data.

Results:
The results showed a significant improvement for the exercise group in the Reach Test for the forward (%Δ= 18.51%), right (%Δ= 20.0%), and left (%Δ= 17.7%) directions and in the 6-Minute Walk Test (%Δ= 12.09%, all Ps < .001) after the intervention.

Conclusion:
The elastic band training provides a simple and inexpensive exercise program that improves the balance control and consequently functional mobility effectively.
Challenges in estimating the impact of vaccination with sparse data
Authors: Shioda Kayoko , Schuck-Paim Cynthia , Taylor Robert J. , Lustig Roger , Simonsen Lone , Warren Joshua L. , Weinberger Daniel M. 
Published: April 2018

ABSTRACTBackgroundThe synthetic control (SC) model is a powerful tool to quantify the population-level impact of vaccines, because it can adjust for trends unrelated to vaccination using a composite of control diseases. Because vaccine impact studies are often conducted using smaller subnational datasets, we evaluated the performance of SC models with sparse time series data. To obtain more robust estimates of vaccine effects from noisy time series, we proposed a possible alternative approach, “STL+PCA” method (seasonal-trend decomposition plus principal component analysis), which first extracts smoothed trends from the control time series and uses them to adjust the outcome.MethodsUsing both the SC and STL+PCA models, we estimated the impact of 10-valent pneumococcal conjugate vaccine (PCV10) on pneumonia hospitalizations among cases <12 months and 80+ years of age during 2004-2014 at the subnational level in Brazil. The performance of these models was also compared using simulation analyses.ResultsThe SC model was able to adjust for trends unrelated to PCV10 in larger states but not in smaller states. The simulation analysis confirmed that the SC model failed to select an appropriate set of control diseases when the time series were sparse and noisy, thereby generating biased estimates of the impact of vaccination when secular trends were present. The STL+PCA approach decreased bias in the estimates for smaller populations.ConclusionsEstimates from the SC model might be biased when data are sparse. The STL+PCA model provides more accurate evaluations of vaccine impact in smaller populations.