bluuebunny/crossref_metadata_2025_split huggingface dataset:
Telemedicine to Improve Maternal Safety: A Statewide Survey of Hospitals in an Obstetric Hemorrhage Collaboration [5OP]
Authors: Einerson Brett D. , Baksh Laurie , Fisher Janet , Clark Erin A.S. 
Published: May 2017

INTRODUCTION:
Multidisciplinary obstetric hemorrhage patient safety bundles can improve response to hemorrhage and reduce maternal morbidity. Broad dissemination and implementation of these bundles, across institutions and geographic regions, has remained challenging. We implemented a novel, statewide, telemedicine-based education program and evaluated programmatic effect on self-assessed preparedness, prevention, response, and reporting domains within the obstetric hemorrhage patient safety bundle.

METHODS:
All Utah hospitals were invited to participate in the Obstetric Hemorrhage Collaborative, an evidence-based educational program aimed at facilitating implementation of the obstetric hemorrhage bundle. The program involved two in-person training meetings and twice-monthly teleconferencing with expert mentorship over 6 months. A statewide self-assessment survey of 38 bundle elements was administered before initiation of the project and after completion. Modified Likert scales were used to describe participant responses. Means and proportions were compared before and after the training.

RESULTS:
Twenty-seven (61%) of Utah’s obstetric hospitals, representing every hospital system in the state completed the needs-assessment survey. Fifteen (34%) participated in the Obstetric Hemorrhage Collaborative. Hospitals reported implementation, or progress toward implementation, of significantly more elements of the bundle after the educational program compared to before (33.3 vs 19.0, p < 0.001). Hospitals reported increased implementation of elements in all four bundle domains. All participants (100%) reported that teleconferencing sessions were “very helpful,” and 14 (93%) were “very satisfied” with the Collaborative.

CONCLUSION:
Utah hospitals report improved implementation of an obstetric hemorrhage bundle as result of a novel educational program using telemedicine. This represents a potentially cost-effective strategy to improve widespread adoption of obstetric hemorrhage bundles.
Readability of Online Patient Educational Materials Provided by Major Gynecological Societies [16OP]
Authors: Nwachuku Nneoma , Carson TreChelle , Fahimuddin Fatimah , Samuel Memorie , Mitchell Rochanda , McDonald Vanessa 
Published: May 2017

INTRODUCTION:
Major medical societies remain a reliable and accessible resource for online patient educational materials. While it is advised that patient educational materials remain at or below sixth grade reading level, the readability of most online educational content provided by such societies often exceeds this recommendation. Gynecological societies play an important role in providing online health information to women. However, a comprehensive review of non-obstetric patient education materials has not yet been undertaken. The purpose of this study is to determine whether patient educational materials provided by major American gynecological societies adhere to current patient readability recommendations.

METHODS:
Three hundred and five non-obstetric articles from the online patient education sections of six gynecological societies were reviewed. Patient readability was analyzed using the Flesch-Kincaid reading scale and a corresponding grade level was assigned.

RESULTS:
The average grade level of reviewed patient educational material was 11.3 ±3.0. When analyzed by category, patient material about Contraception had the lowest mean grade level (7.9±4.0), while material on Surgical Treatment had the highest mean grade level (13.5±4.0). Only one of the gynecological societies presented any material that was at or below the recommended sixth grade reading level.

CONCLUSION:
Online patient educational material provided by major gynecological societies rarely adhere to currently readability guidelines. This may prove a significant barrier to patients achieving health literacy. While major gynecological societies excel at providing current, evidence-based material to a wider population, efforts must be placed on ensuring that the average patient can understand the message conveyed.
Genetic Testing Costs and Compliance With Clinical Best Practices [19OP]
Authors: Ruzzo Kathleen , Sale Taylor J. , Willis Mary J. , Harding Aaron J. , Lutgendorf Monica A. 
Published: May 2017

INTRODUCTION:
The rapid expansion of genetic testing has resulted in increased costs and utilization. Previous studies have shown a financial benefit to review of genetic testing by genetic counselors. We sought to determine the costs of genetic testing and compliance with published guidelines and clinical best practices at our institution.

METHODS:
This is an approved quality improvement project. We identified the charts associated with the genetic test billing codes for common genetic tests sent through LabCorp (cystic fibrosis, BRCA, factor V Leiden, prothrombin, alpha-thalassemia, hemochromatosis, and cell free DNA). We reviewed charts retrospectively to assess the compliance with published clinical practice guidelines identified on Gene Reviews. Tests were classified as: appropriate, mis-ordered/not indicated, mis-ordered/false reassurance, and mis-ordered/inadequate. Cost analysis was performed for recommended test changes.

RESULTS:
We reviewed 114 charts over the 3 month period. Forty four (38.6%) of the tests were mis-ordered based on published clinical practice guidelines: 24 (21%) were mis-ordered/not indicated, 8 (7%) were mis-ordered/false reassurance, and 12 (10.5%) were mis-ordered/inadequate. Costs of ordered testing ($75,177.41) were compared to recommended testing after review ($54,264.83), with a total cost savings of $20,912.58.

CONCLUSION:
In clinical practice, over 1/3 of genetic tests reviewed were mis-ordered As these tests are a small fraction of all genetic tests at our institution, future studies should broaden the scope of testing evaluated to understand the magnitude of this problem and potential cost savings. Genetic counselor review and/or involvement in genetic test ordering can decrease inappropriate healthcare expenditures and improve patient care.
Missed Opportunities to Identify Cardiovascular Disease in Women With Prior Preeclampsia [22OP]
Authors: Lewnard Irene , Brener Alina , Jones Cresta , Mackinnon Jennifer , Wenzlaff Miranda 
Published: May 2017

INTRODUCTION:
Cardiovascular disease (CVD) is the number one killer of American women. Since 2011, the American Heart Association has recognized that women with prior preeclampsia have an increased risk for CVD equal to diabetics and smokers, and since 2013 the American College of Obstetricians and Gynecologists (the College) has recommended early screening for these patients. There are currently no guidelines in the internal medicine literature for CVD screening in women with prior preeclampsia, leading to a provider knowledge gap and missed opportunities to screen high risk women.

METHODS:
We performed a retrospective chart review of 89 women ages 18 to 48 with at least one prior delivery who presented for a well-woman visit after 2013, when the College guidelines were released. We assessed documentation of preeclampsia versus traditional risk factors for CVD (smoking, diabetes, and hypertension) and whether CVD screening was performed according to College guidelines.

RESULTS:
21/89 women were asked about preeclampsia while 88/89 were asked about diabetes or smoking and 89/89 were asked about hypertension. Our data was analyzed using a test of two proportions to compare how often providers asked about preeclampsia compared to smoking, diabetes, and hypertension. The p value was statistically significant at 0.0002 in each individual comparison group.

CONCLUSION:
We identified a knowledge gap at our academic institution among internal medicine providers regarding preeclampsia as a major risk factor for CVD. We see this as an opportunity to improve provider education and ensure continuum of obstetrical to primary care, preventing CVD in high risk women.
Fetal Damage in Congenital Zika Virus Infection: Cohort Study [3P]
Authors: Suely de Oliveira Melo Adriana , Fonseca Schamber Reis Bruno Luiz , Azevedo Girlene Souza , de Sales Tavares Jousilene , Loureiro Marinho Jacqueline Ramos , Amorim Melania M. 
Published: May 2017

INTRODUCTION:
Brazil recently, mainly the Brazilian Northeast, was affected by an epidemic of Zika virus. This epidemic was accompanied by an increase in the birth of infants with microcephaly. In addition to microcephaly other injuries were observed.

METHODS:
This is a preliminary analysis of a cohort study involving 500 pregnant women with symptoms suggestive of Zika. The women came to the service during the symptoms and blood and urine were collected for RT-PCR. They were subjected to ultrasonography at 24 and 32 weeks. Pregnant women with positive PCR for Zika done neurosonography, amniocentesis and Magnetic resonance.

RESULTS:
The findings were then initially classified into three patterns whose findings are repeated in degrees more or less severe: 1 - the classic pattern of microcephaly, where we observe a reduction in the size of the brain and head, with coarse calcifications, however the structure is more conserved, 2 - the destructive pattern where basic structures not be identified and 3 - a third pattern, with more discrete signals as isolated calcifications, slight alterations in neuronal migration pattern or other extracranial changes. Until this date the most cases showed the pattern I (70%). Most Class II cases died. The pattern III is still rare, with a better prognosis and usually occurs when the infection occurs in later periods of pregnancy.

CONCLUSION:
Because it is a new disease, there are still more questions than answers and among them, what are the factors that leads to different aggressiveness patterns and other damage we can find.
Sonographic Findings in Congenital Zika Virus Infection: Cohort Study [4P]
Authors: Suely de Oliveira Melo Adriana , Carneiro Juliana Garcia , de Oliveira Melo Fabiana , Bianka de Souza Manhães Cláudia , Silva Mariana Balbino , Amorim Melania M. 
Published: May 2017

INTRODUCTION:
The Congenital Zika Virus Infection was first observed in the Northeast of Brazil, being confirmed by amniocentesis in November 2015. From the first findings characterized by microcephaly, ventriculomegaly, arthrogryposis and injuries of posterior fossa, other findings were being identified.

METHODS:
A prospective cohort study that followed 500 pregnant women with symptoms suggestive of ZikV. The women collected blood and urine to search ZikV by RT-PCR and they were submitted to ultrasound and came to the service. We also evaluated ultrasound performed in other services. The ultrasounds were performed in Samsung WS80 Elite.

RESULTS:
Among the 500 pregnant women evaluated, 96 showed positive PCR for Zika and 32 had some brain damage. The mean gestational age of the first finding was 27 weeks, with a minimum age of 14 weeks. The most common early finding was mild ventriculomegaly, followed by calcifications and changes of posterior fossa. Arthrogryposis was observed in severe cases. The mean age at diagnosis of microcephaly, when present, was 28 weeks. The average age at birth was 39 weeks, ranging from 29 to 42 weeks. The average head circumference was 30 cm ranging from 23 to 36 cm and the mean birth weight was 2775 grams, ranging between 1060 and 3770 grams.

CONCLUSION:
Despite microcephaly is the most frequent sign of the syndrome of congenital Zika, it is generally not the first sign and is not always present.
Advanced Ultrasound Technology and Its Application to Gynecologic Practice [11P]
Authors: Fernandez Carlos , Miller Daniel , Levine Elliot , Locher Stephen 
Published: May 2017

INTRODUCTION:
In 2015, the American Journal of Obstetrics and Gynecology published an opinion supporting ultrasound as the first-line imaging choice in obstetrics and gynecology. Recent advances in 3D gynecologic ultrasound, which includes volumetric calculation and Power Doppler Angiography (PDA) have expanded the practical functionality and diagnostic ability for complex gynecologic conditions. The authors seek to demonstrate this with a case series, comparing the imaging results and the clinical value obtained.

METHODS:
The described case series includes: 1) Case of missing/broken/embedded IUD complication: located and characterized with 3D gynecologic ultrasound; 2) Case of deeply invasive endometriosis: characterized with 3D gynecologic ultrasound; 3) Improved mapping of uterine fibroids for definitive surgical treatment: characterized by 3D gynecologic ultrasound; 4) Case of endometrial cancerous polyp in a 28 year old, identified with 3D, PDA, volumetric calculation, histogram and Vascularity Index (VI); 5) Case of endometrial carcinoma after negative biopsies: diagnosed via 3D gynecologic ultrasound; 6) Case of an intramural ectopic pregnancy: diagnosed and managed with 3D, PDA, volumetric calculation, histogram and VI.

RESULTS:
Our case series demonstrates the substantial clinical benefit this modality offers over traditional 2D ultrasound, as well as CT and MRI. Each case shows a unique application of advanced ultrasound technique in gynecologic practice.

CONCLUSION:
Advances in gynecologic ultrasound are underutilized in current practice. Gynecologists should be aware of the availability and benefits that can result from the use of these advances.
Cervical Index: A Novel Sonographic Parameter to Predict Preterm Labor [12P]
Authors: Petrikovsky Boris , Terrani Michael , Sichinava Lali 
Published: May 2017

INTRODUCTION:
Midtrimester transvaginal cervical length assessment is widely used to identify patients at risk for preterm labor with variable success. We propose a new ultrasound marker — cervical index (CI) a ratio of cervical length and width, and report its correlation with preterm birth (PTB).

METHODS:
This was a retrospective cohort study of singleton gestations. Demographic data and pregnancy outcomes were collected. Transvaginal ultrasound was performed during routine 2nd trimester ultrasound (16-24 weeks). Cervical indexes were calculated in each case. ROC curves were developed to determine an optimal cutoff of UCA for prediction of PTB < 34 weeks and < 37 weeks. Primary outcome was prediction of PTB by CI. Data were evaluated using χ2 or Fishers Exact test with p < 0.05 as significant. A total of 408 women met inclusion criteria. The rate of PTB in this cohort was 8.1% for delivery < 37 weeks, and 6.4% for < 34 weeks.

RESULTS:
CI of less than 1 is significantly associated with PTB with a sensitivity of 82% (p < 0.005) RR 4, specificity 50%, PPV 18%, NPV 98%. A CI between 1 and 2 predicted PTB with a sensitivity of 80% (p < 0.005) RR 7.2, specificity 58%, PPV 14%, NPV 98%.

CONCLUSION:
CI of less than 1 and between 1 and 2 detected during the 2nd trimester is associated with an increased risk for PTB < 37 and < 34 weeks, respectively. Our data suggest that CI may be a useful, novel ultrasound marker predictive of PTB.
Is Abdominal Circumference Associated With Poor Outcomes in Fetuses With Estimated Fetal Weights Between 10-20th%? [17P]
Authors: Ortega Marcus V. , Leung Katherine , Delpapa Ellen , Moore Simas Tiffany A. , Leftwich Heidi 
Published: May 2017

INTRODUCTION:
Fetuses with intrauterine growth restriction (IUGR) are at increased risk for poor perinatal outcomes. Fetuses with estimated weights (EFW) between 10-20th percentile also have increased risk for poor outcomes. Abdominal circumference (AC) has been shown to have high specificity and sensitivity for IUGR. We aim to determine whether AC is associated with increased risk for poor outcomes with EFW between 10-20th percentile.

METHODS:
Retrospective cohort study assessing pregnancies with ultrasound EFW between 10-20th% between 2005 and 2016. AC, maternal demographics and perinatal outcomes were documented and compared. P less than .05 was considered statistically significant.

RESULTS:
Of 285 patients with EFW 10-20th%, 56 (20%) had follow up ultrasounds. Of these, 59% had evidence of IUGR on follow up fetal growth surveillance and over 60% were documented as small for gestational age (SGA) at birth, regardless of AC. Fetuses with AC on ultrasound less than 10th% showed no increased risk of poor perinatal outcomes including 5 minute Apgar less than 7, NICU admission, SGA or composite outcome, nor did those with AC less than the 5th% in unadjusted or adjusted analyses.

CONCLUSION:
While our cohort with EFW 10-20th% has a high rate of IUGR on follow up ultrasound and SGA at birth, AC does not appear to be associated with other investigated poor perinatal outcomes. Given the high incidence of IUGR and SGA, follow-up ultrasounds could be considered if delivery not otherwise indicated. Further investigation identifying those at highest risk is warranted.
Effect of Assisted Reproductive Technology on the Occurrence of Birth Defects: A Population-Based Study [25P]
Authors: Maor Gil Shechter , Czuzoj-Shulman Nicholas , Spence Andrea , Abenhaim Haim Arie 
Published: May 2017

INTRODUCTION:
Studies have shown that births conceived with Assisted Reproductive Technology (ART) may be associated with a greater risk of birth defects compared with non-ART births. The purpose of our study is to evaluate the association between ART and births defects using a large population-based database set in the United States.

METHODS:
We used the Centers for Disease Control and Prevention's Period linked birth-infant death data files and fetal death database for 2011 to 2013 to conduct a retrospective cohort study consisting of live births during that period. Multivariate logistic regression was used to determine the adjusted effect of ART on birth defects, both overall and by specific defects.

RESULTS:
Between 2011 and 2013 there were 11,862,780 live births, of which 11,791,730 were spontaneous pregnancies and 71,050 were conceived by ART, with an increasing trend in incidence of ART during this 3-year period and an overall increasing trend of birth defects during the study period. Overall, infants conceived by ART had a greater risk of having birth defects compared with infants conceived spontaneously (77/10,000 vs 24/10,000, respectively, OR 2.20, 95% CI 2.00-2.42). The most malformation most commonly associated with ART was cyanotic heart defects (OR 2.74, 95% CI 2.42-3.09) while other malformations included cleft lip and/or palate and hypospadias.

CONCLUSION:
There is an increased risk of birth defects, overall and of specific types, in the ART population. Appropriate counseling and specialized ultrasound evaluations should be considered in pregnancies conceived by ART
Does Oral Contraceptive Use Lessen the Impact of Concussions in Adult Female Athletes? [28P]
Authors: Chace Kathleen , Bachmann Gloria , Simonds Adrienne , Dettwiler Annegret 
Published: May 2017

INTRODUCTION:
Sports-related concussion (SRC) is classified as a mild traumatic brain injury (mTBI) and occurs over 2 million times annually. Female athletes acquire SRCs at higher rates and experience poorer outcomes and increased cognitive impairment compared to males. Progesterone has been utilized as intervention for TBI because of its neuroprotective effects. Applicability of this research to female athletes is limited because of predominantly male subject populations, failure to measure endogenous progesterone levels, menstrual cycle phase at time of injury, and oral contraceptive pill (OCP) use. The purpose of this research was to explore the role of oral contraceptive use on SRC outcomes in women.

METHODS:
A search of the literature was conducted from June to September 2016 using PubMed and OVID databases. Search terms used included: “concussion”; “brain injury”; “menstrual cycle”; “progesterone” “oral contraception”; and “females.”

RESULTS:
76 articles were identified with 5 remaining after applying exclusion criteria. Women on OCPs or in the follicular phase at the time of injury performed significantly better on quality of life and somatic symptom measures. Athletes on OCPs reported fewer concussion symptoms with less symptom severity than eumenorrheic athletes.

CONCLUSION:
Menstrual cycle phase and OCP use at the time of concussion may influence concussion outcomes. OCP use was associated with better outcomes in adult female athletes with SRC. Gender-specific research efforts are necessary to improve outcomes after SRC, including prospective analysis of SRC outcomes and OCP use in female athletes.
PPROM Following Open Fetal Myelomeningocele Repair [2Q]
Authors: Said Heather M. , Vricella Laura K. , Miller Collin , Elbabaa Samer , Vlastos Emanuel 
Published: May 2017

INTRODUCTION:
The objective is to characterize the risk of PPROM following open fetal MMC repair.

METHODS:
This retrospective cohort of 51 patients who underwent open fetal MMC repair was analyzed in two groups based on PPROM. Primary outcome was occurrence of PPROM. Secondary outcomes included latency from repair to delivery and gestational age at delivery. Intraoperative factors, obstetric complications and delivery outcomes were also evaluated.

RESULTS:
Demographics were similar between groups. PPROM occurred in 22 patients (43%) at a mean gestational age of 31w1d. Mean latency from surgery to PPROM was 50 days. Patients with PPROM had a lower gestational age at repair (24.7 + 0.7 weeks without PPROM; 23.9 + 1.2 weeks with PPROM; p < 0.007), latency from MMC repair to delivery (78.3 + 17.3 days without PPROM; 61.4 + 25.8 days with PPROM; p = 0.008) and gestational age at delivery (35.9 + 2.6 weeks without PPROM; 32.7 + 3.4 weeks with PPROM; p < 0.005). Patients with PPROM had lower infant birth weights (2614 g without PPROM; 1990 g with PPROM; p=0.001) and one-minute Apgars (7.2 without PPROM; 5.5 with PPROM; p=0.016) but similar five-minute Apgars. In multivariate analysis, greater gestational age at repair was protective against PPROM (RR 0.286; 95% CI 0.095-0.861; p=0.026), as was multiparity (RR 0.122; 95% CI 1.064-62.792; p = 0.043).

CONCLUSION:
PPROM occurred frequently among patients undergoing open fetal MMC repair and was associated with preterm delivery, earlier gestational age at repair and lower one-minute Apgar but not the occurrence of preterm labor, abruption or chorioamnionitis.