bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Association Between Perioperative Outcomes and BMI Among Patients Who Underwent TLH for Uterine Cancer [8J]
Authors: Al Sawah Entidhar , Salemi Jason , Sarkar Papri , Imudia Anthony , Hoffman Mitchel , Mikhail Emad 
Published: May 2017

INTRODUCTION:
Greater degree of obesity can pose surgical challenges in patients who undergo open surgery. As total laparoscopic hysterectomy (TLH) is becoming utilized widely for uterine cancer, our objective is to assess the association between patient body mass index (BMI) and perioperative outcomes.

METHODS:
A retrospective analysis of the American College of Surgeons-National Surgical Quality Improvement (ACS-NSQIP) database during 2005-2013 was conducted. Women with uterine cancer who underwent TLH, including robotically-assisted and conventional routes, were identified. We used preoperative BMI (kg/m2) to estimate the degree of obesity as follows: normal (< 25), overweight (25-29.9), obese (30-39.9), and morbidly obese (≥40).

RESULTS:
TLH was performed in 3630 women with uterine cancer during 2005-2013. Of those, 15.9%, 18.9%, 36.9%, and 28.2% had normal, overweight, obese, and morbidly obese BMI. The mean operation time (minutes) was significantly higher in overweight (159), obese (158), and morbidly obese (171) women than women with normal BMI (145, p < 0.05). The wound infection rate in the morbidly obese group (1.3%) was higher than for normal (0.2%), overweight (0.1%), and obese (0.5%) women (p < 0.05). We did not observe an association between patient BMI and length of hospital stay, incidence of blood transfusion, or thromboembolic episodes.

CONCLUSION:
In women with uterine cancer, morbid obesity was associated with greater risk of deep wound infections and greater operation time following TLH. Hospital stay and readmission within 30 days was not affected by the level of obesity.
Anal Intraepithelial Lesions in HIV-Negative Women With Cervical Neoplasia: A Cross-Sectional Study [12J]
Authors: Amorim Melania , Heraclio Sandra , Souza Alex Rolland , Katz Leila , Souza Paulo Roberto , Junior Sergio Lima 
Published: May 2017

INTRODUCTION:
Evidence suggests a strong association between oncogenic human papillomavirus (HPV) infection, anal high-grade intraepithelial lesions and the development of anal cancer. The objective of this study was to evaluate the prevalence of anal intraepithelial lesions in women with cervical neoplasia.

METHODS:
A cross-sectional study was conducted with 324 HIV-negative women with intraepithelial or invasive cervical neoplasia to identify anal intraepithelial neoplasia (AIN) and risk factors associated. All the women were submitted to anal cytology and high-resolution anoscopy (HRA).

RESULTS:
The prevalence of AIN was 11% (n=37) with 4% of these cases consisting of high-grade lesions. The factors that remained associated with AIN in the multivariate analysis were age ≥36 (OR: 4.55; IC 95%:1.63-12.72; p< 0.001), ≤4 years of schooling (OR: 3.04; IC 95%:1.07-8.62; p=0.03), abnormal anal cytology (OR: 5.96; IC 95%:1.96-18.09 p < 0.001), a vulvoscopy finding of subclinical HPV lesion (OR: 6,94; IC 95%: 1.08-44.55; p= 0,04) and abnormal HRA findings (OR: 7.16; IC 95%:2.63-19.51; p < 0.001).

CONCLUSION:
The prevalence of AIN is high in HIV-negative women with cervical neoplasia. Screening for anal cancer in women with cervical neoplasia should be performed regardless of HIV status.
Racial, Geographic and Socioeconomic Risk Factors for Development of Advanced Stage Cervical Cancer [15J]
Authors: Dilley Sarah , Powell T. Clark , Bae Sejong , Straughn J. Michael , Leath Charles A. , Kim Kenneth H. 
Published: May 2017

INTRODUCTION:
We investigated sociodemographic risk factors for developing advanced stage (AS) cervical cancer, as well as the impact of distance to a women’s health provider on stage at diagnosis.

METHODS:
Our institution tumor registry was queried to identify women treated for cervical cancer from 2005-2015. AS cancer was considered Stage II-IV. Utilizing American College of Obstetricians and Gynecologists data, we calculated minimum distance from patient to the nearest women’s health provider. Associations between stage and multiple factors were calculated using logistic regression.

RESULTS:
934 patients were included, 273 black and 661 white. Mean age at diagnosis: 49.8 (SD 14.7). 493 patients had AS cervical cancer. Average distance to a women's health provider (ACOG Fellow): 7.4 miles. 346 women had private insurance, 431 had public insurance, 128 were uninsured. Black race (OR 1.43) and age > 50 (OR 1.75) were associated with increased risk of AS cancer, however a shorter minimum distance to the nearest women’s health provider (OR 0.995) was not. When stratified by race, insurance status did not have a significant impact on stage at diagnosis for black women. Among white women, those who were uninsured (OR 1.69) or with public insurance (OR 1.93) were more likely to be diagnosed with AS cancer than those with private insurance.

CONCLUSION:
In our analysis, black race remains a strong predictor of diagnosis of AS cervical cancer. These results warrant further investigation into the socioeconomic, cultural and biological barriers to early diagnosis for black women, and highlight the importance of focusing on high-risk populations in efforts to improve cervical cancer screening and prevention.
Statins: A Possible Treatment or Prevention Strategy for Ovarian Cancer [18J]
Authors: Beltran Frans 
Published: May 2017

INTRODUCTION:
Twenty-one thousand women are diagnosed with ovarian cancer yearly and fourteen thousand annually die from it. A promising drug-class with the potential to treat and prevent ovarian cancer is statins. One likely mechanism under investigation on statin’s anti-cancer properties is by inhibition of cell proliferation, migration and invasion through inhibition of Rho-A and Rho-C GTPases.

METHODS:
In a cohort of women diagnosed with epithelial ovarian cancer (EOC) at Hershey Medical Center, we compared cases on statin therapy at diagnosis to age and stage matched controls without statin use. Tissue pathology was immunohistochemically (IHC) stained for Rho-A and Rho-C. Tissue samples were examined under high resolution microscopy. Exact Mantel-Haenszel Chi-Square Test was used to analyze staining differences for Rho-A and Rho-C between cases and controls and between early stage disease (I-II) and advance stage disease (III-IV). Tissue sample stains were graded blindly and given a score and intensity.

RESULTS:
We identified 12 cases and 16 controls in an attempted 1:2 matching. There were no difference in score and intensity for Rho-C between cases and controls, nor between early and advanced stage disease. Differential IHC staining score was identified for Rho-A between cases and controls but no significant difference between the two groups.

CONCLUSION:
EOC stains for Rho-A and Rho-C, and Rho-A is differentially expressed in EOC. We were unable to find a significant difference in staining likely due to the small sample size. There remains strong potential for refashioning statins to treat and prevent deadly EOC and warrants further investigation.
Trends in Cervical Cancer Screening Versus National Guidelines [23J]
Authors: Polcari Ann M. , Hecht Eric 
Published: May 2017

INTRODUCTION:
Guidelines for cervical cancer screening via pap smear changed in 2012. Previous studies suggest mixed opinions about extended screening intervals. This descriptive study relates trends in pap smear use with the new recommendations.

METHODS:
Self-reported pap smear information from 2012-2014 Behavioral Risk Factor Surveillance System (BRFSS) surveys were weighted for the US population and subsequently analyzed using SPSS per The BRFSS Data User Guide. Age groups were determined by the 2012 cervical cancer screening guidelines.

RESULTS:
American women who reported “ever having a pap” declined 1.3% from 2012-2014. Specifically, Paps performed in 18-20 year olds decreased from 38.6% (n=2,580,856) to 27% (n=1,703,912). During this time period, the estimated percentage of women who “had a pap within the last year” declined from 53.6% (n=57,395,954) to 48.4% (n=49,965,054). In 2014 alone, approximately 70% (n=1,184,449) of 18-20 year olds and 23.6% (n=4,832,250) of women over 65 had their most recent pap within the previous year. Conversely, the number of women with a 3-year interval between Paps increased from 7.8% (n=8,327,940) to 9.5% (n=9,831,709) from 2012-2014.

CONCLUSION:
National Pap smear use is slowly aligning with 2012 guidelines, yet screening trends remain problematic. From 2012-2014, many women aged 18-20 or over 65 underwent a pap while no longer indicated, and few women utilized the extended interval. This can increase use of invasive follow-up procedures, anxiety, and cost, therefore contributing to excessive healthcare spending. Continued analysis of national pap testing will guide future studies that may unveil causes of excessive cervical cancer screening from the physician and patient perspective.
The 2012 Consensus Pap Test Guidelines: A Failure of Patient Education [24J]
Authors: O'Flynn O'Brien Katherine , Flynn Anne , Burkland Danielle , Karpin Karin , Krapf Jill , Haggerty Ashley 
Published: May 2017

INTRODUCTION:
The 2012 consensus cervical cancer screening guidelines recommend longer intervals between Papanicolaou (Pap) tests. We evaluated the knowledge and attitudes of women regarding the purpose and frequency of Pap test screening.

METHODS:
A 13-question survey was available to patients 18 years and older presenting to three clinical sites for obstetrical or gynecological care. Survey topics included familiarity with the 2012 consensus screening guidelines, cervical cancer knowledge, and attitudes towards screening.

RESULTS:
Updated data from 752 patients was included for analysis. Participants were primarily age 20-29 (45%) or 30-39 (33%), African American (53%), and had completed at least a high school degree or equivalent (87%). Pap tests were correctly identified as a screening test for cervical cancer by 75% of participants and 72% named Human Papillomavirus as the cause of cervical cancer. However, only 9% of women selected the correct screening intervals for patients age 21-29 and only 3% selected the appropriate screening interval for patients age 30 and above. Overall, 52% were uncomfortable with lengthening screening intervals and 60% would prefer a yearly pap test. However, 62% of women believed that additional education would increase their comfort with less frequent screening.

CONCLUSION:
Across diverse clinical populations, women are knowledgeable about the purpose of Pap tests and about cervical cancer. However, consistent with our previous data analysis, most women are unaware of the updated screening guidelines and many feel uncomfortable with increased screening intervals. Further education regarding the timing of pap tests is necessary to improve women’s comfort with the consensus guidelines.
Effects of Race and Socioeconomic Factors on Emergency Department Management of Threatened Abortion [26J]
Authors: Cheng Connie , Bernstein Steven , Fan Linda , Evans Leigh 
Published: May 2017

INTRODUCTION:
Among women presenting with pregnancy-related complications, demographically-based differences in incidence, outcomes, and treatment are known. Here we determine the effects of race, insurance, and hospital characteristics on threatened abortion management.

METHODS:
Patient record files from National Hospital Ambulatory Medical Care Survey with diagnosis of threatened abortion, hemorrhage in pregnancy, or incomplete or unspecified spontaneous abortion from 2002-2010 were examined using logistic regression. Primary outcomes were rates of admission and active management (surgical or pharmacological treatment). Covariates included race/ethnicity, age, insurance, and hospital location, ownership, and metropolitan status.

RESULTS:
Of 5,882,623 ED visits for threatened abortion, 15% were admitted; 1.3% were actively managed. Compared to white women, black women were less likely to be admitted (0.83, 95% CI 0.83-0.84), but more likely be actively managed (OR 4.37, 95% CI 4.25-4.50). Admission was more likely for “Other” women of color (OR 2.14, 95% CI 2.11-2.17), Medicaid/SCHIP (OR 1.24, 95% CI 1.22-1.25) and Self-paying women (OR 1.04, 95% CI 1.03-1.05). Historically-marginalized groups, including uninsured, black, and “Other” women, were more likely to be actively managed. Exceptions were Latina (OR 0.84, 95% CI 0.80-0.89) and Medicaid/SCHIP-insured women (OR 0.13, 95% CI 0.12-0.15).

CONCLUSION:
Black women are less likely than white women to be admitted for threatened abortion, but more likely to be actively managed. Other nonwhite and uninsured women are more likely to be admitted and actively managed, excepting Latinas. The etiology of these disparities is complex. Providers may seek to better understand their own preconceptions of patient risk, and to improve social support and shared decision-making.
Obstetrician/Gynecologists' Attitudes, Knowledge and Caring of Lesbian, Bisexual, and Transgender Patients [32J]
Authors: LaSota Emily , DiCorcia Mark , Daggy Joanne 
Published: May 2017

INTRODUCTION:
This study assessed the attitudes, knowledge and experiences caring for lesbian, bisexual, and transgender (LBT) patients among members of a national group of obstetrician-gynecologists.

METHODS:
Members of the American College of Obstetricians and Gynecologists (the College) who attended College meetings in Denver and Indiana completed a survey assessing care practices, knowledge and attitudes toward LBT patients.

RESULTS:
196 out of 425 (46.1%) physicians completed the survey. Most physicians often or sometimes ask about sexual orientation, but they rarely ask about gender identity. Over 98% feel comfortable treating lesbian and bisexual patients, but 30% believe a provider should be allowed to decline to treat LBT patients if it conflicts with the provider’s religious beliefs. Over 84% agree that their workplace is a safe place for LGBT patients, but most do not have or know if they have office measures that would create a welcoming space, such as posted nondiscrimination policies or LGBT employee training. The majority screen LBT patients at the same rate as non-LBT patients for depression, substance abuse, and cervical cancer. Physicians reported that self-directed learning and experiences with LBT patients were more valuable forms of LBT education than formal training in medical school, residency or CME.

CONCLUSION:
Physicians in obstetrics and gynecology recognize and address issues regarding sexual orientation. Physicians feel comfortable treating LBT patients but are dissatisfied with formal training they receive on LBT health issues. While most believe that their workplaces are safe environments for LBT patients, much more can be done to ensure that patients perceive them to be safe.
Addressing Loss of Low Risk Obstetric Patients to Postpartum Care in an Inner City Hospital [11E]
Authors: Maher Lauren , Rose Marisa 
Published: May 2017

INTRODUCTION:
Postpartum appointments after discharge from uncomplicated deliveries are integral to building patient-physician relationships, screening for complications, decreasing emergency department visits, and preventing readmissions. At Temple University Hospital, patients were responsible for scheduling their own follow-up appointments after delivery.

METHODS:
A retrospective chart review was performed to evaluate the rate of patient initiated postpartum follow up. A new approach to improving attendance at postpartum visit was instituted using an electronic scheduling system at the time of discharge. Patient return rates were prospectively monitored comparing patients using the old and new system.

RESULTS:
In 2012-2013, 62.5% of patients of patients attended self-initiated follow-up appointments. In 2013-2014, 23% of patients had their follow-up appointments scheduled through the electronic system and 62% of these women attended their follow-up appointments. In the same year, 84% of patients attended self- initiated follow-up appointments and the overall attendance rate was 63% of postpartum patients. In 2014-2015, 62.5% of patients had their follow-up appointments scheduled through the electronic system. Of these, 48% of patients attended their follow-up appointments compared to 88% who attended appointments they scheduled themselves, with an overall follow up rate of 56.5%.

CONCLUSION:
Implementation of a model where postpartum appointments are scheduled through the electronic system has not increased the rates of follow up for low risk obstetric patients. Future plans include a pilot study of scheduling postpartum appointments during a term prenatal visit and contacting patients the week of their scheduled appointments to remind them of the appointment date and time.
The Impact of Florida’s Prescription Drug Monitoring Program on Neonatal Abstinence Syndrome [39F]
Authors: Roussos-Ross Dikea , Triplett Kimberly 
Published: May 2017

INTRODUCTION:
The Florida Prescription Drug Monitoring Program (PDMP), E-FORCSE, was implemented in response to the national opioid epidemic in 2011 as a way to decrease inappropriate prescribing and access to opioid medications.

METHODS:
A retrospective chart review was conducted at UF Health at the University of Florida in Gainesville, FL with IRB approval. Data was collected from January 1, 2012 to December 31, 2015. We investigated the in-hospital length of stay, hospital charges associated with observation and treatment of newborns affected by neonatal abstinence syndrome (NAS), type of treatment required (eg, pharmacologic, supportive), and type of opioid exposure during pregnancy.

RESULTS:
Three hundred twenty-three eligible newborns were included in the study. The average length of stay for newborns diagnosed with NAS, requiring only supportive measures was 4.6 days. The average length of stay for newborns diagnosed with NAS requiring pharmacologic management was 14.4 days. Over the four year study period, hospital charges related to the diagnosis and treatment of NAS increased from $1.7 million in 2012 to $2.5 million in 2015. The percentage of newborns diagnosed with NAS requiring pharmacologic management increased from 53.8% in 2012 to 64.5% in 2015.

CONCLUSION:
Despite the initiation of the PDMP in Florida, there was no noted decrease in the incidence of NAS. In fact, the incidence of NAS, hospital charges, and length of stay all increased over the length of the study. Encouraging use of contraception, including LARC, may decrease the incidence of unintended pregnancy and may play a part in decreasing in-utero exposure to opioids.
Quality of Web-Based Pregnancy and Fertility Health Information for LGBT Individuals [39H]
Authors: Kreines Fabiana M. , Mou Tsung , Razavi Armin , Chervenak Frank , Grunebaum Amos 
Published: May 2017

INTRODUCTION:
There is little scientific pregnancy and fertility information available online for the lesbian, gay, bisexual, and transgender (LGBT) community. In an age where individuals acquire a significant portion of their medical information online, it is important to have validated and reliable medical information available, especially because of the unique family building obstacles faced by LGBT individuals. The purpose of this study is to evaluate the quality of web-based reproductive health information for LGBT individuals.

METHODS:
The first 25 relevant websites that resulted from a Google-based search and met specific LGBT family building search criteria were analyzed for health-related information using the National Quality Health Website Survey (NQHWS) instrument.

RESULTS:
76% of the websites (19/25) belonged to fertility clinics and constituted mostly vehicles for advertisements to the LGBT community for these clinics. No website identified source of funding, described medical, editorial, or quality review practices or policies. No website met more than 75% reliability criteria, and 76% (19/25) met less than 50%. Only 32% (8/25) mentioned adoption as an option or made any mention of reproductive options provided to transgender individuals. Additionally, only 48% (12/25) of websites made any mention of legal resources to help navigate LGBT family building in this country.

CONCLUSION:
This is the first study applying validated reliability criteria (NQHWS) to evaluate online information regarding LGBT reproductive options. Medically reliable websites for the LGBT community are greatly needed to provide sufficient information on family building for the LGBT community.
Efficacy of Intrauterine Lidocaine and Naproxen for Pain Control With Intrauterine Device Insertion [1A]
Authors: Miles Shana , Shvartsman Katerina , Dunlow Susan 
Published: May 2017

INTRODUCTION:
One of the barriers to IUD insertion is discomfort during the placement of the device. This study was designed to compare the efficacy of intrauterine lidocaine and oral naproxen sodium on discomfort and pain of patients undergoing intrauterine device insertion.

METHODS:
This is a randomized, double-blind, placebo-controlled study where women were randomly assigned to receive either 5mL of intrauterine 2% lidocaine or saline and either 375mg of naproxen sodium or placebo tablet. Patients were randomized into one of four randomly assigned groups: A placebo/normal saline infusion; B placebo/lidocaine infusion; C: naproxen/normal saline; D: naproxen/lidocaine. We enrolled 80 women into the Mirena IUD arm of the study.

RESULTS:
There was no significant difference between the 4 groups in age, parity, chronic pelvic pain, menopausal status, or difficulty in placing the IUD. The mean pain scores of the women in the naproxen only (2.89+/-2.05), lidocaine only (2.37+/-1.98), and combined naproxen/lidocaine (3.55+/-2.46) groups were not significantly different as compared to placebo (3.2+/-2.25). Pain rated by the physician was not significantly lower in the treatment groups as compared to placebo.

CONCLUSION:
Oral naproxen and intrauterine lidocaine instillation does not appear to significantly decrease pain associated with Mirena IUD insertion.
Impact of Telemedicine Monitoring of Community ICUs on Interhospital Transfers*
Authors: Pannu Jasleen , Sanghavi Devang , Sheley Todd , Schroeder Darrell R. , Kashyap Rahul , Marquez Alberto , Daniels Craig E. , Brown Daniel R. , Caples Sean M. 
Published: May 2017

Objectives:
To study the effects of tele-ICU monitoring on interhospital transfers from community-based ICUs to the quaternary care hospital at Mayo Clinic, Rochester, MN.

Design:
This is a retrospective review of data on interhospital transfers comparing trends prior to tele-ICU implementation to those following implementation.

Setting:
Tele-ICU programs are increasingly utilized to fill resource gaps in caring for critically ill patients. How such programs impact population and bed management within a healthcare system are not known. Mayo Clinic serves as quaternary referral care center for hospitals in the region within the Mayo Clinic Health System. In August 2013, we implemented tele-ICU monitoring at six Mayo Clinic Health System hospital ICUs.

Subjects:
All adult ICU admissions during the study period (preimplementation phase: January 1, 2012, to December 31, 2012; and postimplementation phase: January 1, 2014, to December 31, 2014) in any of the six specified community ICUs were included in the study.

Measurements and Main Results:
Interhospital transfers significantly increased post institution of tele-ICU (p = 0.040) and was attributed primarily to transfer from less specialized ICUs (p = 0.037) as compared with more resource-intensive ICUs (p = 0.88). However, for such patient transfers, there were no significant differences before and after severity of illness scores, ICU mortality, or inhospital mortality.

Conclusion:
In a regional healthcare system, implementation of a tele-ICU program is associated with an increase in interhospital transfers from less resourced ICUs to the referral center, a trend that is not readily explained by increased severity of illness.