bluuebunny/crossref_metadata_2025_split huggingface dataset:
Accuracy of Leopold's Maneuver Compared to Ultrasound in Estimating Fetal Birth Weight [12B]
Authors: Tell Noor , Omuso Inara , Hunter Krystal , Khandelwal Meena 
Published: May 2019

INTRODUCTION:
Estimation of fetal birth weight is a critical data point that can affect the management of women in term labor. However, the superior method of estimating fetal birth weight (EFW) using Leopold's maneuvers versus ultrasound continues to be debated. This study aimed to compare the accuracy of clinical estimation with that of ultrasound-guided estimation. This study also evaluated the accuracy of both methods with Body Mass Index (BMI).

METHODS:
This retrospective study was IRB-approved and included singleton pregnancies between 37 and 42 weeks of gestation admitted for labor and delivery, between 2013 and 2014. Included women had ultrasound and clinical estimation of EFW using Leopold's maneuvers. The statistical tests used include McNemar and t-test.

RESULTS:
A total of 102 women were randomly selected, and 1 was excluded for missing data. The mean maternal age was 29.2 (+/-5.9); 25.5% were African American, 25.5% Hispanic, and 39.2% White. Of the 101 women, 42 women had an ultrasound completed within 14 days before birth. The accuracy of clinical EFW and ultrasound EFW within 20% of actual birth weight was 88.1% and 71.3%, respectively, overall (p=0.003); but in women in whom the ultrasound was completed 14 days prior to birth, there was no difference (p=0.45). BMI has no significant effect on the accuracy of EFW via either method.

CONCLUSION:
In our sample, there is no significant difference in accuracy of clinical and ultrasound EFW. Obstetricians should continue to teach and practice Leopold's maneuver because of its practicality, availability, and lack of cost compared to ultrasound-guided estimation.
Association of Proinflammatory and Proinsulinemic Food Groups With Maternal Postpartum Weight Retention [18B]
Authors: Mahabamunuge Jasmin , Simione Meg , Horan Chrissy , Redline Susan , Davison Kirsten , Taveras Elsie 
Published: May 2019

INTRODUCTION:
Few studies have examined associations of maternal intake of proinflammatory and proinsulinemic food types with substantial postpartum weight retention (SPPWR; ≥5 kg) at 6 months.

METHODS:
We studied 308 mother-infant pairs enrolled in the Rise and SHINE study, a longitudinal birth cohort. Maternal diet, including consumption of foods with proinflammatory and proinsulinemic properties such as sugar-sweetened beverages (SSBs), red/processed meats, sweet snacks and fast food, and fruit/vegetables, was assessed in the third trimester and at 1-month postpartum via the NHANES Dietary Screener Questionnaire. Postpartum weight retention was calculated as the difference between pregravid and 6-month postpartum weight.

RESULTS:
At 6-months, 29.6% of the mothers had SPPWR. In multivariable analyses adjusted for race/ethnicity, income, maternal age, pre-pregnancy BMI and gestational weight gain, we found that each additional serving/day of SSBs was associated with higher odds of SSPWR (OR: 1.43; 95% CI: 1.11, 1.85). Intake of red/processed meats (OR: 1.97; 95% CI: 0.55, 7.13) in the third trimester, and SSBs (OR: 1.27; 95% CI: 0.94, 1.72), red/processed meats (OR: 1.96; 95% CI: 0.83, 1.12) and fast food (OR: 1.35; 95% CI: 0.17, 10.79) at 1-month postpartum were also associated with higher odds of SPPWR but confidence intervals were wide and spanned 1.0.

CONCLUSION:
Our results show that consumption of SSBs, and possibly other proinflammatory and proinsulinemic foods in the third trimester and 1-month postpartum is associated with SPPWR. Avoiding such beverages and foods during this window may reduce SPPWR and the risk for long term weight retention.
Definition and Incidence of Severe Surgical Site Infections After Cesarean Delivery [24B]
Authors: Ross Naima , Messina Maria , Robinson Letrease , Saiman Lisa , Goffman Dena , Duffy Cassandra 
Published: May 2019

INTRODUCTION:
Surgical site infections (SSI) are common complications following cesarean delivery. As part of a performance improvement project, we recognized the need to differentiate infections based on severity and thus sought to characterize the most severe cases of SSI.

METHODS:
We performed a retrospective review of women ≥18 years or older who delivered by cesarean in 2016 and 2017 at a Women's Hospital. Using a combination of ICD-10 diagnosis codes, the electronic medical record, and infection control surveillance, we identified cases and confirmed all diagnoses by chart review using CDC definitions for SSI. We defined severe SSI as cases requiring additional treatment (change in antibiotics or additional procedure), readmission, CT imaging, ICU admission, or length of stay ≥7 days. We compared maternal demographics and clinical characteristics between severe and non-severe cases using the Student t-test and Fischer exact test as appropriate.

RESULTS:
Among 3,507 cesarean deliveries, 141 met criteria for SSI. Of these, there were 53 cases of severe SSI. Women with severe SSI were older (31.9 vs. 30.2 years, p=0.01), had lower gestational ages at delivery (35.8 vs. 37.6 weeks, p<0.01), were more likely to have diabetes (26.4% vs. 10.2%, p=0.02) and less likely to have endometritis only (50.9% vs. 81.8%, p<0.01). There was no difference between groups in BMI, prior cesarean, hypertension, GBS status, length of labor or rupture of membranes, or emergent/urgent deliveries.

CONCLUSION:
In our cohort, severe SSI was associated with older age, diabetes, and earlier deliveries. Further research is needed to identify modifiable risk factors and guide prevention strategies.
Neonatal Outcome Differences Among Providers With Lower Nulliparous, Term, Singleton Vertex Cesarean Rates [30B]
Authors: Wong Melissa Spring , Wells Matthew , Govindappagari Shravya , Gregory Kimberly D. 
Published: May 2019

INTRODUCTION:
While increasing rates of cesarean deliveries are known to be associated with worsening maternal and neonatal outcomes, it is unknown whether there are adverse effects to maternal or neonatal outcomes by significantly lowering the cesarean rate. The objective of this study was to identify whether there were differences in maternal or neonatal outcomes among providers with lower NTSV cesarean rates.

METHODS:
A retrospective cohort study of all providers performing deliveries at an academic, tertiary care, community hospital from 2011-2017. Efforts were ongoing to lower the hospital NTSV rate. Providers were analyzed individually and in groups according to whether their cumulative NTSV was greater or less than 23.9%. Outcomes of interest included rates of severe maternal morbidity (SMM) and indicators of neonatal morbidity: abnormal cord blood gases, 5-minute APGAR, and term neonatal intensive care unit (NICU) admission.

RESULTS:
46,597 deliveries were performed by 91 unique providers. NTSV cesarean rates ranged from 7.6-68.0%. There were no differences in rates of SMM, abnormal cord blood gases or 5-minute APGAR scores. Term NICU admission rates, however, did differ: providers who had NTSV cesarean rates ≤23.9% had higher NICU admission rates compared to those whose NTSV cesarean rate was >23.9% (6.55% vs 4.54%), though this was not statistically significant. Analyzed at an individual provider level, there was a statistically significant positive correlation between NTSV cesarean rates and NICU admission (p=0.006).

CONCLUSION:
Providers with lower NTSV cesarean rates were noted to have higher term NICU admission rates.
Can Our Words Hurt? Effects of Using Phrases With Unpleasant Emotional Connotation on Perceived Pain [31B]
Authors: Echeverri Natalia , Fletcher Michelle , Timmons Douglas B. , Palin Hannah , Florez Laura , Carugno Jose 
Published: May 2019

INTRODUCTION:
The insertion of a speculum is a common procedure performed during a gynecologic exam. With the intention to improve the patient experience, healthcare providers often use terms with unpleasant emotional content such as “it will feel uncomfortable” to guide patients through medical procedures. It is assumed that such words help patients but there is little evidence to support this belief. The objective of this study is to evaluate the impact of using phrases of anticipated discomfort on the perception of pain and discomfort during speculum exams.

METHODS:
A randomized single blind trial in patients undergoing speculum examination during their well woman gynecologic visit. Patients were randomized to the anticipated discomfort group were the following phrases were used “You are going to feel pressure” “This will be very uncomfortable” or the objective description group “I am going to introduce the speculum” and “I am going to open the speculum.” Patient were asked to rate the pain perceived during the speculum exam using the Wong-Baker facial grimace scale. Descriptive statistic was used to analyze the data.

RESULTS:
Both groups were similar regarding age, BMI, ethnicity, menopausal status and parity. Patients from the objective description group rate the pain perceived during the speculum exam at 0.8 ±SD: 0.8 compared to 2.9 ±SD: 1.5 (p<0.000). The objective group were also more likely to describe the pain as less than anticipated (p<0.000) in the post exam questionnaire.

CONCLUSION:
The use of phrases with unpleasant emotional content significantly worsened the pain perception during speculum examination.
No Association Between HPV Vaccination and Infertility in U.S. Females 18-33 Years Old [33B]
Authors: Mooney Katherine , LoConte Noelle , Conway James , Zhang Xiao , Schmuhl Nicholas B. , Lauer Jacob K. 
Published: May 2019

INTRODUCTION:
Human papillomavirus (HPV) infections are associated with adverse human reproductive health outcomes: miscarriages, preterm delivery, lower pregnancy rates, and poor semen quality. Fecundity may also be reduced by surgery for HPV-related cervical dysplasia. HPV immunizations could improve fertility by preventing HPV infections. Claims have been made suggesting HPV vaccines negatively affect reproductive capacity. This study examined the relationship between HPV immunization status and infertility using data from a nationally-representative sample.

METHODS:
Data were analyzed from the 2013-2016 National Health and Nutrition Examination Surveys, which included queries regarding respondents' intentions and unsuccessful attempts to become pregnant, as a proxy for infertility. To confine the sample to respondents who were young enough to be offered HPV vaccine and old enough to have infertility concerns, only females between 18 and 33 years old (N=1,092) were included. Logistic regression models, stratified by marital status, were performed to examine the association between the proxy measure of infertility and HPV vaccination.

RESULTS:
Univariate models indicate that HPV vaccination is inversely associated with infertility among women who have ever been married (OR 0.46, 95% CI 0.23-0.93), but not associated for women never married (OR 0.87, 95% CI 0.39-1.95). After adjustment for age, race/ethnicity, family income levels, and education, there is no association between HPV vaccination and infertility for ever-married females (OR 0.61, 95% CI 0.35-1.08) or never-married females (OR 0.84, 95% CI 0.34-2.08).

CONCLUSION:
There was no association between HPV immunization and inability to become pregnant when desired. This information is valuable given public concerns regarding vaccine safety and persistently low HPV immunization rates.
HDAC6 & DNMT Inhibition Alter Immunogenicity of Ovarian Cancer Cells: A Rationale for Combination Therapy [39B]
Authors: Moufarrij Sara Maria , Srivastava Aneil , Hadley Melissa , Lopez Micael , Villagra Alejandro 
Published: May 2019

INTRODUCTION:
Therapies that activate the immune system to fight cancer have shown robust responses in solid tumors. However, most patients, including those with ovarian cancer, do not respond to these therapies alone. We are testing the combination of epigenetic modifiers DNA methyltransferase inhibitor 5 azacytidine and selective histone deacetylase 6 inhibitor Nexturastat A, in stimulating immunogenesis in an ovarian cancer model.

METHODS:
We hypothesize that the combination of HDAC6i and 5-AZA will enhance tumor immunity alone and when used in combination. We used qRT-PCR to detect amplification of cytokines, Western blot for protein expression and cell culture in addition to flow cytometry to measure the cell types and protein expression in the ascites milieu in a murine ovarian cancer model.

RESULTS:
Immunoblots showed that PD-L1, a marker of poor prognosis in ovarian cancer, decreased after treatment with Nexturastat A and even more in combination with 5-AZA. Additionally, the combination therapy upregulated cytokines involved in the T cell and Natural Killer cell response. Treatment with the drug combination in a murine model of ovarian cancer significantly reduced tumor burden and prolonged survival. Flow cytometry analysis of ascites favored an immunogenic microenvironment.

CONCLUSION:
PD-L1 decreased after treatment with Nexturastat A and even more so when combined with AZA, while interferon stimulated genes were upregulated with combination treatment. We observed enhanced survival and decreased tumor burden in a murine ovarian cancer model when treated with Nexturastat A and 5-AZA, as well as a more favorable immune microenvironment in the mice treated with epigenetic drugs.
Medical Student Education in Pregnancy Options Counseling: A Systematic Review [2C]
Authors: Farmer Lauren E. , Clare Camille Angela 
Published: May 2019

INTRODUCTION:
Background: Non-directive pregnancy options counseling is an important skill for medical students to learn as physicians of multiple specialties will counsel patients regarding their desired pregnancy outcome. APGO lists options counseling as a “shows how” skill for all undergraduate medical students. Despite this, it is only taught at 36% of medical schools with an average of 60 minutes spent per school. Thus, students and faculty have attempted to supplement existing curriculum due to concerns about medical student competency.

PURPOSE:
To review peer-reviewed literature on pregnancy options counseling in undergraduate medical education.

METHODS:
A systematic search of Google Scholar and PubMed for post-2000 literature using keywords, “pregnancy options counseling,” “medical student education,” “OSCE,” “student competency.” Inclusion criteria were English language studies of M.D. and D.O. programs in North America with a discussion of both pregnancy options counseling and medical education.

RESULTS:
Educational modalities used most frequently included objective structured clinical examinations (OSCEs) (57%), novel clinical and patient experiences (43%), faculty run workshops (38%) and online teaching modules (14%). The most popular timing of interventions was 3rd year OB/GYN and family medicine clerkships (71%). Students routinely left out the following topics in counseling: adoption, intimate partner violence and reproductive coercion.

CONCLUSION:
Common educational modalities utilized to supplement medical student education include online modules, clinical shadowing, novel clinical experiences, role play, and OSCEs. The optimal combination of these modalities has yet to be elicited. However, much work has been done in the last five years to advance the OSCE as a learning tool for options counseling.
Systematic Review of Access to Emergency Contraception for Sexual Assault Victims in U.S. Emergency Departments [3C]
Authors: Wang Michelle , Khodadadi Alexandra , Turan Janet , White Kari 
Published: May 2019

INTRODUCTION:
We conducted a systematic review of the literature to assess the prevalence in hospital protocols and policies for providing emergency contraception (EC) to sexual assault survivors in US emergency departments (EDs).

METHODS:
We searched PubMed and CINAHL from inception to October 2017 for studies that assessed access to EC for sexual assault survivors in EDs. We included English-language studies that surveyed ED staff at US hospitals and reported the percentage of hospitals with policy on EC for sexual assault survivors and the frequency with which survivors were counseled, offered and received EC on-site. Secondary outcomes included the percentage of hospitals that provided prophylaxis for sexually transmitted infections (STIs) and HIV and offered STI and HIV testing.

RESULTS:
From 390 articles retrieved, 14 studies met the inclusion criteria. Eligible studies surveyed the staff and administrators at 3,314 hospitals. In eight of nine studies, 52-83% of hospitals had a policy on EC; a study published in 2000 reported 28% of hospitals with an EC policy. Additionally, 42-83% of hospitals provided EC counseling, 34-83% offered EC, and 45-81% had EC available to dispense onsite. Fewer studies reported on the secondary outcomes. Overall, 81-92% provided STI prophylaxis, 38-90% provided STI testing, 14-69% provided HIV prophylaxis, and 11-81% provided HIV testing.

CONCLUSION:
Our findings demonstrate significant variability in policies and practices to provide EC for sexual assault survivors across US hospital EDs. Identifying and reducing barriers to EC counseling and dispensing would ensure sexual assault survivors can access this essential service, regardless of their source of care.
Trends in Postpartum Uptake of Long-Acting Reversible Contraception Between 2012 and 2016 [4C]
Authors: Noon Brigit , Lerma Klaira , Kharsa Zena , Shaw Kate 
Published: May 2019

INTRODUCTION:
This study aimed to evaluate trends in postpartum uptake of long-acting reversible contraception (LARC) at Stanford Children's Hospital between 2012 and 2016.

METHODS:
We reviewed medical records for all women delivering after 24-weeks gestation with the Stanford teaching service during 2012 and 2016. We documented and compared contraceptive plan at the time of hospital discharge, immediate postpartum uptake of LARC, and interval uptake of LARC by 8-weeks postpartum.

RESULTS:
Among 1141 deliveries in 2012 and 985 in 2016, 27.6% and 27.1% desired LARC at the time of hospital discharge, respectively. Immediate postpartum uptake increased from 2.9% in 2012 to 17.5% in 2016 (p<0.001). Among those receiving prenatal care at our institution, attendance at a postpartum visit was 75.6% (666/881) in 2012 and 82.3% in 2016 (548/666; p=0.002). In this sub-set, immediate uptake of LARC increased from 2.5% (22/881) to 16.2% (108/666; p<0.001), whereas interval uptake increased from 4.3% (38/881) to 5.1% (34/666; p<0.001). Among these patients and those who desired LARC, immediate uptake increased from 10.3% (23/223) to 64.9% (113/174; p<0.001), whereas interval uptake did not increase significantly (15.2% in 2012 and 10.3% in 2016, p=0.08). In a binary logistic regression analysis, younger age, public insurance, and multiparity were significantly associated with increased uptake in all sample sub-sets.

CONCLUSION:
Uptake of LARC by 8-weeks postpartum increased dramatically from 2012 to 2016. The observed increase was driven by an increase in immediate postpartum initiation. Future efforts should focus on identifying women who desire postpartum LARC prior to delivery and facilitating immediate postpartum insertion.
Medical Students Encounter Values Conflicts Frequently in Clerkships: A Need for Values Clarification Education [5C]
Authors: Chaudhari Sonal , Zuo Stephanie , Robinson Jennifer , Patel Silka 
Published: May 2019

INTRODUCTION:
Few models of medical school clinical curricula emphasize values clarification (VC) education. VC is a psychotherapy technique that can help individuals increase awareness of personal values, reflect on personal moral dilemmas and allow values to be analyzed and clarified.

METHODS:
We surveyed students after they participated in a VC session, facilitated by trained faculty and centered around the topic of abortion, during their Women's Health (WH) clerkship at Johns Hopkins University School of Medicine. IRB committee approval was obtained (IRB 00106073).

RESULTS:
66% of medical students responded to our survey (n=115). 83% of students agreed or somewhat agreed that a session dedicated to values clarification regarding difficult patient scenarios would be beneficial during their clinical rotations. At least 68% of students reported encountering conflicts in which their values were different from their patients' in multiple clerkships. 79.1% completed more than one clerkship before WH. Of significance, students encountered values conflicts more frequently in WH clerkship compared to Surgery (n=71, p=0.013) and Neurology (n=36, p=0.002). After participation in our VC session, greater than 75% of students agreed or somewhat agreed that they gained increased awareness of personal values and values conflicts as well as increased empathy.

CONCLUSION:
VC education is essential in medical clinical curricula because students encounter difficult patient scenarios and values conflicts. Providing such education is not a time-consuming addition to clinical curriculum, as we were able to accomplish this in an hour for a group of 25-30 students. We encourage medical schools to endorse VC education in clinical medical curricula.
Surrogate Motherhood: Need for Continued Research and Comprehensive Education [6C]
Authors: Tedeschi Catherine , Bachmann Gloria A. 
Published: May 2019

INTRODUCTION:
As assisted reproductive technology (ART) is continuously progressing and changing, society, the medical community and legal systems are struggling to keep pace. ART often challenges social norms, religious beliefs, and current legislation, with resultant negative outcomes at times. Professional societies are addressing this issue, but one area of research, that of surrogate motherhood, is limited. Informed consent and the safeguarding of gestational carriers must be examined to ensure their comprehensive education, counseling and protection.

METHODS:
A review of the PubMed database, Google Scholar, and other accessible information via Google was conducted.

RESULTS:
Though rates of surrogate pregnancies are on the rise, reaching over 3,400 gestational carriers in 2013, there are limited data regarding the repercussions for gestational carriers themselves. Moreover, the educational resources for potential surrogate mothers are scant. The MeSH heading “Surrogate Mothers” on the PubMed database registers only 1,583 hits, but a Google search of this term yields approximately 4,770,000 hits. When searching via Google Scholar, a more academic, yet accessible resource, this search term yields approximately 116,000 hits. Moreover, there is a lack of long-term follow-up on the surrogate mothers themselves, with few studies following up after 1 year.

CONCLUSION:
There appears to be insufficient patient education and a scarcity of comprehensive long-term research that should be addressed in order for the medical community to safeguard the emotional and physical health of gestational carriers.