bluuebunny/crossref_metadata_2025_split huggingface dataset:
Obstetrician/Gynecologist Perception of Prescription Drug Monitoring Program Effectiveness [15I]
Authors: Goodin Amie , Brown Joshua , Freeman Patricia , Henry Stephen , Talbert Jeffery , Delcher Chris 
Published: May 2019

INTRODUCTION:
Prescription drug monitoring programs (PDMPs) are primary prevention tools designed to reduce rising rates of substance use disorders (SUD) and sequelae such as neonatal abstinence syndrome. Evidence regarding OB/GYN perceptions of PDMPs, which may impact PDMP utilization, is unavailable. This study examines perceived PDMP effectiveness among OB/GYNs compared to primary care physicians (PCPs).

METHODS:
In the absence of national-level data, independent surveys of PDMP users in Florida, Kentucky, and California were evaluated based on a Likert-type item to assess perception of PDMP effectiveness in reducing prescription drug abuse and diversion. Response distributions of OB/GYNs versus PCPs were compared using chi square tests for each state.

RESULTS:
In Florida, there were 41 OB/GYN and 511 PCP respondents; Kentucky, 46 OB/GYNs and 265 PCPs; and California, 41 OB/GYNs and 162 PCPs. In each state OB/GYNs viewed PDMPs as less effective, positive, or useful compared to PCPs (p≤0.01, all states). Florida: 64.1% OB/GYN vs. 83.7% PCP “agree positive impact”. Kentucky: 45.0% OB/GYN vs. 68.5% PCP “effective”. California: 73.2% OB/GYN vs. 86.4% PCP “useful”.

CONCLUSION:
These results suggest OB/GYNs view their state's PDMP as less effective than do PCPs. These perceptions may present barriers to PDMP utilization and decrease opportunities for SUD interventions. Outreach and guidelines to OB/GYNs regarding PDMP effectiveness as a SUD screening tool would be helpful. Further engagement of all prescribers, including OB/GYNs, is needed to inform future strategies, programs, policies and PDMP features to increase PDMP effectiveness.
Dilation and Evacuation of Thoracopagus Conjoined Twins per Vagina at 26 Weeks [20I]
Authors: Hern Warren M. , Landgren Benedict 
Published: May 2019

INTRODUCTION:
Conjoined twins are an exceedingly rare obstetric occurrence with very poor neonatal outcomes. They are often delivered by low transverse or classical cesarean, even following induced or spontaneous fetal demise of a third-trimester fetus, due to perceived difficulty in achieving a vaginal delivery.

METHODS:
A 24-year-old with two prior full-term vaginal deliveries and a 26-week thoracopagus twin gestation presented desiring termination of pregnancy. The fetal prognosis was low chance of survival to separation surgery, with planned delivery by classical cesarean. Ultrasonography suggested adjacent or partly fused fetal hearts, with a possible shared pericardial sac. An uncomplicated induction of fetal demise was performed by intrafetal digoxin injection into the pericardium. A routine protocol was followed including a multiple laminaria treatment of the cervix followed by rupture of membranes, intrauterine placement of 400mcg of misoprostol and induction of labor by low dose oxytocin. This protocol resulted in ample cervical dilation and breech delivery of both twins to the umbilicus. Separation of the thoracopagus connection by sharp dissection facilitated disarticulation. Following intact delivery of the first twin, the second twin's calvarium was decompressed and delivered. Combined fetal weight was 1051 g, placental weight was 451 g, and measured blood loss was 250 cc.

CONCLUSION:
Late abortion techniques can avoid invasive surgeries, reduce risk and improve outcomes for complicated pregnancies presenting challenges for vaginal delivery. Such techniques involve a combination of surgical D&E techniques with induction and delivery.
HSDD, Flibanserin, and Eye Dynamics: A Double-Blind Randomized Placebo-Controlled Clinical Trial [24I]
Authors: Cacioppo Stephanie , Kaske Erika , Siewsrichol Wasuwat , Millheiser Leah 
Published: May 2019

INTRODUCTION:
The Cacioppo neurofunctional model of hypoactive sexual desire disorder (HSDD) suggests an attentional visual deficit when looking at attractive stimuli, characterized by a deficit in orientation and disengagement. Little is known, however, about the effect of flibanserin on eye dynamics in women with HSDD.

METHODS:
A total of 24 premenopausal women who met DSM-IV TR criteria for HSDD were randomized to either flibanserin 100mg or placebo over an 8-week period (N=12, flibanserin, N=12 placebo; N=15 heterosexual; N=9 bisexual; mean age: 32.79 ± 9.17 years). Eye movements were recorded in our standard behavioral task i.e., the Desire Intention Task (DIT), in which individuals are instructed to indicate as rapidly and accurately as possible whether or not each visually presented stimulus (e.g., attractive persons of the opposite sex) is sexually desirable to them at the moment of the experiment. Participants then completed a series of self-reported questionnaires (e.g., demographics, level of sexual desire, well-being, anxiety and depression).

RESULTS:
Results showed an effect of flibanserin on the re-orientation of attention towards attractive stimuli. More precisely, a 2x2x2 repeated measures ANOVA with visit (baseline, 4 weeks) and visual attentional region of interest (face, torso) as within-subjects factors and treatment group (flibanserin, placebo) as a between-subjects factor revealed a significant interaction for duration of first fixation to the face (F(1,21)=5.046, P=.043, ηp2 = .187) and average stimulus duration of fixation from image onset to response (F(1.21)=4.411, P=.047, ηp2 = .167).

CONCLUSION:
These results suggest a positive effect of flibanserin, but not placebo, on eye movements during DIT.
Impact of High Body Mass Index on Perioperative Complications of Hysterectomies Using a National Registry Database [25I]
Authors: Ursillo Lauren , Fazzari Melissa , Ali Fahd , Pereira Musa Fernanda Baptista , Jimenez Edward , Chalas Eva 
Published: May 2019

INTRODUCTION:
To evaluate the impact of high body mass index (BMI) on perioperative outcomes following hysterectomies reported to the National Surgical Quality Improvement Program (NSQIP).

METHODS:
Retrospective analysis of NSQIP database Participant Use Data File (PUF) from 2012 to 2016. Patient characteristics and perioperative complications were evaluated across BMI groups, combining normal and overweight (N/O) group, and utilizing standard definitions for class I, II and III obesity. ICD 9/10 and CPT codes were utilized. Patients were stratified into four groups based on benign vs. malignant diagnosis, and open vs. minimally invasive (MIS) procedure. Exclusion criteria were invalid CPT codes, BMI < 18, or missing data. Cochran-Armitage trend tests were used to examine linear trends in rates across increasing BMI category.

RESULTS:
Of 202,929 hysterectomies, 173,669 (85.6%) were eligible for analysis. Increases in obesity over time were noted with 50.5% classified as obese in 2016 vs. 46.5% in 2012 (p<0.001). For all procedures, as BMI category increased the rate of wound complication increased. In benign disease, overall complication rates also increased with BMI (MIS: 7.7% in normal BMI to 9.31% in class III, Open: 14% to 22.4%; p < 0.001). In open procedures, wound, sepsis, and readmission rates increased for obese patients, regardless of diagnosis (p < 0.001).

CONCLUSION:
Hysterectomy procedures for obese women were associated with increased perioperative complications. Obese patients had higher rates of wound complications regardless of surgical approach or diagnosis, and had higher rates of sepsis and readmission in open procedures regardless of diagnosis.
Comparison of Mobility and Pain With the Use of an Abdominal Binder Versus No Abdominal Binder Post Cesarean Delivery [27I]
Authors: Makarova Natasha , Tussey Christina , Erickson Laurie Paullette 
Published: May 2019

INTRODUCTION:
Given our national epidemic with opioid use, clinicians look for non-pharmacologic options for postoperative pain control. The abdominal binder has been used in the postoperative period, but research has been inconclusive regarding the effectiveness for cesarean section patients. The purpose of this study was to compare use of an abdominal binder to no binder in women following cesarean delivery, specifically looking at pain and ambulation.

METHODS:
This was a randomized controlled trial at single academic medical center, between February and June 2018. Eighty-two post-cesarean section women were randomized to using an abdominal binder (binder arm) or not using a binder (control). Ambulation frequency, time from surgery, amount of pain medication taken, and pain scores before and after ambulation were recorded. Symptoms of distress were reported by a questionnaire 24 and 48 hours post-surgery. Patient demographics were assessed by electronic record review.

RESULTS:
Of the 82 patients, 48 were randomized to the binder arm. Controlling for parity, the binder group demonstrated less post-ambulation pain than control group (P=.001). Post-hoc general linear modeling was used to evaluate pain before and after ambulation and showed that women who wore a binder had less pain than women in the control group. There were differences in pain medications between groups. There were no statistical differences in the time to ambulation following surgery or in distress symptoms between groups. There were no statistically significant differences between demographics, except for parity.

CONCLUSION:
Abdominal binders may be associated with decreased postoperative, post-ambulation pain and can be used as a non-pharmacologic alternative.
Compliance With Repeat Antibiotic Dosing in Selected Cesarean Deliveries [29I]
Authors: Janssen Matthew , Stechna Sharon Beth , Ralston Steven J. , Sehdev Harish M. 
Published: May 2019

INTRODUCTION:
Proper antibiotic administration reduces surgical site infection and perioperative morbidity. Recent data suggests these practices are not as established in obstetrics as other surgical specialties. We analyzed compliance with institutional guidelines for antibiotic administration in selected cesarean deliveries.

METHODS:
An institutional IRB approved retrospective analysis of cesarean deliveries over a 14-month time period with an estimated blood loss (EBL) of greater than 1,500 cc, operative times longer than four hours, or pre-delivery maternal weight greater than 120 kg were analyzed for antibiotic administration. Data was obtained from the electronic health record at multiple sites of an academic medical center. Antibiotic standards followed institutional guidelines. We evaluated the percentage of patients that received appropriate surgical prophylaxis.

RESULTS:
Six cesarean deliveries had an operative time of greater than four hours and all six received adequate antibiotic dosing. Fifty-seven patients with cesarean deliveries had an EBL greater than 1,500cc and 19 (33%) patients received an additional dose of antibiotics. Of 280 cesarean deliveries with pre-delivery maternal weight greater than 120 kg, 146 (52%) received adequate surgical prophylaxis.

CONCLUSION:
A significant number of patients did not receive repeat antibiotic dosing during cesarean delivery, when EBL was greater than 1500 cc or maternal weight was greater than 120 kg. We have implemented educational initiatives for obstetric and anesthesia providers as well as intraoperative check-points to improve communication. The goal is to continue along the plan-do-study-act method to achieve higher rates of antibiotic use and analyze effectiveness of our quality improvement strategy. We will study the effectiveness of our interventions over time.
Early Versus Late Amniotomy During Induction of Labor in Obese Gravida [37I]
Authors: Minor Kathleen , Leung Katherine , Allocco Elizabeth Rose , Knutson Karin Britta , Delpapa Ellen , Lauring Julianne 
Published: May 2019

INTRODUCTION:
The purpose of this study is to compare early (≤4 cm) versus late (>4cm) amniotomy in obese women undergoing induction of labor and the effect on mode of delivery.

METHODS:
This is a secondary analysis of a retrospective cohort study that obtained IRB approval to investigate induction and augmentation of labor and BMI. Obese women undergoing induction of labor, with term, vertex, singleton pregnancies, with amniotomy as an intervention from 2012 to 2017 were included. Our primary outcome was mode of delivery. Secondary outcomes included length of labor, maximum dose of oxytocin required, adverse neonatal and maternal outcomes. Comparisons were made between those with early amniotomy at cervical exam ≤4 cm, and late amniotomy with cervical exam >4cm.

RESULTS:
The sub-analysis included 286 women. There was no difference in cesarean delivery rates between early and late amniotomy (21% vs. 12.7%, P=.075). Early amniotomy was associated with longer time from amniotomy to delivery (6.6 hours vs. 3.7 hours, P <.001). Early amniotomy was not associated with a statistically significant reduction in time to vaginal delivery, or vaginal delivery <24 hours from initiation of induction. Early amniotomy was associated with higher maximum dose of oxytocin. There was no statistically significant difference in hemorrhage, chorioamnionitis, NICU admissions or APGAR scores <7 at 1 minute.

CONCLUSION:
In an obese population, early amniotomy was not associated with an increase in cesarean delivery or increases in maternal or neonatal complications, but it did not appear to be associated with shorter labor course.
Changes in Narcotic Use after Initiation of an Advanced Surgical Recovery Program [4J]
Authors: Geisler John Patrick , Seeley Neil , Manahan Kelly J. 
Published: May 2019

INTRODUCTION:
To determine the differences in opioid use (IV and total) in post-operative period and 90 days after surgery for patients undergoing radical complete debulking for ovarian cancer before and after initiation of an advanced surgical recovery program.

METHODS:
Medical records were examined for the last 50 patients before initiation of the program and for the first 75 patients after the initiation of the program undergoing radical complete debulking for ovarian cancer. Only patients not on narcotics before surgery were included. Opioid amounts were converted to morphine equivalents (ME). Demographics, opioid use and prolonged use of narcotics (>90 days after surgery) were also collected. IRB approval was either obtained or waived for the study.

RESULTS:
Mean pre-initiation IV (71.2 ME (95%CI 33.1-109.3)) and total (85.8 ME (95%CI 42.0-129.6)) opioid use was significantly higher before initiation of the program than after initiation: IV (4.2 ME (95%CI 1.0-7.9)) and total (21.9 ME (95%CI 15.5-28.3)). This correlates with a 94.1% decrease in IV narcotic use and 74.5% decrease in total narcotic use. At 90 days after surgery, the continued use of narcotics decreased from 6% to 1.3% (P <0.001) after initiation of the program. The mean age and BMI of the pre- (50.2 years (95%CI 47.5-52.0); 29.7 kg/m2 (95%CI 28.6-30.9) and post-initiation (51.5 years (95%CI 49.6-53.4); 31.1 kg/m2 (95% CI 30.2-31.9) were not significantly different.

CONCLUSION:
After initiation of an advanced surgical recovery program designed to decrease narcotic use, there were both significant decreases in post-operative opioid use and in chronic opioid use at 90 days.
Does Amitriptyline Work as Preemptive Analgesia in Abdominal Hysterectomies? [6J]
Authors: França Neto Antonio Henriques , Amorim Melania , Marinho Alexandre M. 
Published: May 2019

INTRODUCTION:
Pain prevention is an important challenge for surgeons, since the painful sensation is a factor related to greater morbidity in the postoperative period. The introduction of preemptive analgesia appears to be an inexpensive, simple and effective alternative. The use of amitriptyline as a strategy for this type of analgesia has been proposed, but there are no studies associating this drug specifically with patients submitted to hysterectomy.

METHODS:
A randomized clinical trial was performed comparing 145 inpatients submitted to hysterectomy receiving 25 mg of amitriptyline (n=72) or placebo (n=73), six hours before the surgery. Pain was measured 6, 12, 24 and 48 hours after the procedure, using an algometer and visual pain scale (VPS). This study was approved by the local Institutional Review Board. All participants will be informed about the objectives of the project and only will be included if they agree to participate, signing the informed consent.

RESULTS:
There was no statistically significant difference between the groups amitriptyline and placebo. The pain measured using an algometer and VPS were extremely similar. Side effects and the other aspects tested were also similar.

CONCLUSION:
Amitriptyline appears not be effective as preemptive analgesia for patients submitted to abdominal hysterectomy. It's important to say that the patients in this study used multimodal analgesia, which is the routine in the hospital where they were operated. Further studies are necessary to shown if Amitriptyline can be effective in other types of surgery.
Efficacy of LF111, an Investigational, Drospirenone-Based Progestogen Oral Contraceptive [10J]
Authors: Kimble Thomas Dudley , Burke Anne E. , Barnhart Kurt T. , Colli Enrico , Archer David F. 
Published: May 2019

INTRODUCTION:
Progestogen only oral contraceptives are associated with a decreased risk of venous thromboembolism making them indicated in women who are breast feeding or present contraindications to estrogens, including obesity, age > 35 years and smokers. Drospirenone (DRSP), a progestogen derived from spironolactone with a pharmacological profile similar to natural progesterone possesses anti-mineralocorticoid and anti-androgenic activity.

METHODS:
Multicenter, open-label trial in sexually active females ≥15 years seeking contraception were administered LF111 (4.0 mg DRSP: x 24 days with x 4 placebo tablets) in 13 sequential cycles of 28 days each. The Pearl Index (PI) was calculated in evaluable cycles in the overall population (Full Analysis Set [FAS]) and in non-breastfeeding women (modified FAS; [mFAS]) aged ≤35 at the time of enrollment, who received at least one dose of LF111, excluding discontinued sites.

RESULTS:
The FAS and mFAS comprised 1004 and 993 subjects, respectively. The PI in 5337 evaluable cycles in 903 non-breastfeeding subjects with 12 confirmed on-drug pregnancies was 2.9 (95% CI 1.5-5.1). The overall PI in 5835 exposure cycles in 903 subjects with 12 confirmed pregnancies was 2.7 (95% 1.4-4.7). The PI for method failures in 2664 perfect cycles in 908 subjects with 7 pregnancies was 3.4 (95% CI 1.4-7.0). There were no pregnancies in women >35 years.

CONCLUSION:
The primary endpoint, PI from evaluable cycles in non-breastfeeding women age ≤35 years at the time of enrollment, showed that LF111 provided effective contraception protection with a PI of 2.9., historically comparable to recently approved combined oral contraceptives.
The Effect of Linzagolix on Bone Mineral Density (BMD): Safety Results From a Dose-Ranging Trial [21J]
Authors: Bestel Elke , Humberstone Andrew , Lecomte Veronique , Loumaye Ernest , Gotteland Jean-Pierre , Simon James A. 
Published: May 2019

INTRODUCTION:
Linzagolix is a new, non-peptide, GnRH receptor antagonist being developed to treat endometriosis-associated pain (EAP). The EDELWEISS trial is a Phase 2b, double-blind, randomized, placebo-controlled, multicenter, dose-ranging trial in and Europe evaluating oral once daily doses of 50, 75, 100 and 200 mg taken for 24 weeks. Subjects randomized to placebo were crossed-over to 100 mg after 12 weeks.

METHODS:
IRB approval was obtained. Participants were women with surgically confirmed endometriosis and moderate to severe EAP. Women with a history of osteoporosis or other metabolic bone disease were excluded. BMD of the femoral neck, total hip and lumbar spine was assessed by DXA at baseline and after 12 and 24 weeks of treatment. Reading of DXA scans and monitoring of scan quality, including cross-calibration between sites, was centralized.

RESULTS:
327 patients were randomized and treated. Mean percent (95% CI P value) BMD changes for lumbar spine from baseline to week 24 in the 50, 75, 100 and 200 mg dose groups were 0.137% (-0.83, -1.11 P=.777), -0.798% (-1.57, -0.03 P=.042), -1.365% (-2.14, -0.59, P<.001), -2.602% (-3.56, -1.65, P<.001), respectively. BMD of femoral neck and total hip showed a similar pattern but with generally smaller changes from baseline.

CONCLUSION:
Mean BMD losses at 24 weeks were <1% at doses of 50 and 75 mg and increased with increasing dose up to 2.6% for 200 mg. Long term use of 75 mg daily is not expected to require concomitant estrogen/progestin add-back therapy, while higher doses may require it.
Cervix Elasticity and Length Measurements With Tactile-Ultrasound Probe: First Clinical Experience [32J]
Authors: Rosen Todd , van Raalte Heather , Egorov Vladimir 
Published: May 2019

INTRODUCTION:
Premature cervix softening and shortening may be considered an early mechanical failure that predisposes to preterm birth. Clinical studies demonstrate that cervical elastography may be able to predict spontaneous preterm delivery. The purpose of the study was to access a new approach to cervix elasticity and length measurements based on the acquisition of stress-strain data by tactile and ultrasound transducers.

METHODS:
A Cervix Monitor (CM) was designed to provide a single-use, inexpensive cervix probe with a tactile array and an ultrasound transducer. 10 non-pregnant and 10 pregnant women at 22-29 weeks of pregnancy were examined with the CM in IRB approved studies. Cervix stress-to-strain ratio was used to calculate cervix elasticity (Young's modulus) for four cervix sectors at 3, 6, 9, and 12 o'clock.

RESULTS:
The study with non-pregnant women demonstrated the device safety. The study with pregnant women with gestational age 25.4±2.3 weeks demonstrated cervix elasticity 19.7±15.4 kPa and length 30.7±6.6 mm. Intraclass correlation coefficients between two measurements at the same cervix sector were found to be 0.97 for cervix elasticity and 0.93 for cervix length. The bias and the 95% limits of agreement (Bland-Altman plot) of cervix elasticity measurement are 3.8% and -22.4% to +14.9%, the precision was 9.5%. The bias and the 95% limits of agreement of cervix length measurement are -1.6% and -13.3% to +16.5%, the precision was 7.6%.

CONCLUSION:
The CM stress-strain data allowed computation of cervix elasticity and length. This approach has a potential to provide cervix markers to predict spontaneous preterm delivery in a cost-effective manner.