bluuebunny/crossref_metadata_2025_split huggingface dataset:
Levonorgestrel Intrauterine Device Complications Among Obese Women in a Multiracial Population [21F]
Authors: Saito-Tom Lynne , Ahn Hyeong Jun , Kaneshiro Bliss 
Published: May 2017

INTRODUCTION:
Intrauterine device insertion may be more challenging as a patient’s body mass index (BMI) increases leading to a higher incidence of complications. However, few studies have evaluated this, particularly in a diverse population. This study aims to describe levonorgestrel intrauterine device (LNG-IUD) complications in obese women.

METHODS:
We evaluated BMI in relation to difficulty with IUD insertion (utilization of additional instruments or anesthesia beyond standard practice), 12-month IUD continuation, and IUD complications (expulsion, infection, perforation, pregnancy, and malposition) in a retrospective cohort study of women with a LNG-IUD inserted at Kaiser Permanente-Hawaii between January 2009 and December 2010.

RESULTS:
Of the 1,071 eligible patients, 36% were obese (18% Class I obesity; 10% Class II obesity; 8% Class III obesity). The most common races were Native Hawaiian/Pacific Islander (36%) and Asian (31%). No differences in difficulty with insertion (P=.59) and 12-month continuation (P=.69) were noted between BMI groups. Class III obese women had a higher proportion of any complication [Class III obesity 24% (20/82); Class II obesity 13% (14/107); Class I obesity 10% (19/199); P=.001]. In multivariable logistic regression, Class III obese patients had a 3.06 times higher odds (OR 3.06 95% CI 1.69-5.57) of LNG-IUD expulsion compared to the control group (normal weight, overweight, and Class I obesity) when adjusting for age, insurance, race and breastfeeding.

CONCLUSION:
Class III obesity was associated with higher rates of LNG-IUD complications, particularly expulsions. Further studies that include a larger number of obese women are needed to better understand these findings.
Investigating Pregnancy Outcomes After Abnormal Cell-Free Fetal DNA Test Results [25F]
Authors: Lu Jessica , Saller Devereux N. , Fraer Luanne M. , Chen Beatrice A. 
Published: May 2017

INTRODUCTION:
Cell-free fetal DNA (cfDNA) testing has increased sensitivity and specificity compared to other prenatal screening methods, but invasive diagnostic testing (IDT) is recommended for confirmation. We examined factors associated with pregnancy continuation or termination after abnormal cfDNA results.

METHODS:
We conducted a retrospective chart review of 39 women with abnormal cfDNA results between March 2012 and September 2015 at an urban academic hospital. We analyzed data using descriptive statistics, Fisher exact, and Wilcoxon rank-sum tests.

RESULTS:
Mean age was 33.9±7.6 years; 64% (25/39) were advanced maternal age and 67% (26/39) had abnormal ultrasounds. Median gestational age at time of cfDNA testing was 18 3/7 weeks (interquartile range 12 2/7, 20 5/7). CfDNA results included trisomy 21 (90%, 35/39), trisomy 18 (8%, 3/39), and both trisomy 21/monosomy X (3%, 1/39). Of 39 women, 22 (56%) continued and 10 (26%) terminated the pregnancy; six (15%) had fetal demises and one was lost to follow-up. For women continuing or terminating the pregnancy, pregnancy outcomes were not associated with cfDNA results (P>.99), maternal age (P=.74), race (P=.23), or having abnormal ultrasounds (P=.68). Only 13 women underwent IDT; all had trisomy 21. Of women continuing their pregnancies, 55% (12/22) declined further genetic counseling and 73% (16/22) declined IDT. Most women terminating their pregnancies (80%, 8/10) underwent IDT. Not pursuing IDT was associated with continuing the pregnancy (P=.006).

CONCLUSION:
Over half of women with abnormal cfDNA results continued the pregnancy and declined IDT. Most women terminating their pregnancy pursued IDT, suggesting that women considering termination undergo more confirmatory tests.
Influences of Ethnicity on Perceptions of Contraceptive Use in Postpartum Women With Unintended Pregnancies [26F]
Authors: Skanes-DeVold Heather , Benoit Candace , Erby Brittainy , Ochs Katherine , Maxwell Rose , Lindheim Steven 
Published: May 2017

INTRODUCTION:
Unintended pregnancies (UIP) account for nearly 50% of pregnancies. Studies suggest that minority women are less compliant and less likely to use contraception. We assessed knowledge and attitudes associated with pre- and postpartum contraception use in women with UIP.

METHODS:
A 21-question survey was given to 350 full-term women between the ages of 18 and 40 within 48 hours of delivery from August 2014 to August 2016.

RESULTS:
Of the 195 respondents, 56% were women with UIP. With regards to UIP, 42% were Caucasian (CA), 49% African American (AA), 3% Hispanic and 6% other. The latter two groups were excluded from analysis. CA and AA were similar in education level (61% vs 59% greater than high school), contraception access/insurance coverage (96% vs 96%), use prior to (61% vs 47%) and at the time of conception (14% vs 24%), P-NS. There was no difference in negative perceptions of contraception (CA- 42% and AA-49% P-NS), though weight gain was high in both (CA 72% vs AA 71%, P-NS). AA were less likely to identify benefits of contraception compared to CA (AA 81% vs CA 93%, P < .001), including a reduction in acne (AA 10% vs CA 39% P < .001) and prevention of further UIP (AA 46% vs CA 78%, P < .001).

CONCLUSION:
Understanding the disbelief among AA that birth control has non-contraceptive benefits in addition to effectively preventing pregnancy, may be the first step in the development of culturally targeted education and further aid in the reduction of disparities in UIP.
Pregnancy Outcomes Following Cardiac Transplant [31F]
Authors: Zaffa Nusrat , Bhagra Catriona , Murphy Kellie , Sermer Mathew , Ross Heather , D'Souza Rohan 
Published: May 2017

INTRODUCTION:
We report a single-center experience of pregnancy outcomes for women following cardiac transplantation.

METHODS:
This is a retrospective cohort of all women with pregnancies following cardiac transplantation followed at Mount Sinai Hospital, Toronto, between 2001-2015.

RESULTS:
Five women had five singleton pregnancies following cardiac transplantation. The mean maternal age was 28.4 (±7.7) years and transplant-to-pregnancy interval was 7.1 (±3.6) years. Pre-existing comorbidities included hypertension in three and diabetes in one. Two women experienced graft rejection prior to conception, but had normal left ventricular (LV) function at the start of pregnancy. Three women were on a calcineurin inhibitor (cyclosporine or tacrolimus) with 5-10 mg prednisone per day, one was on tacrolimus + mycophenolate mofetil and one was on cyclosporine, azathioprine and prednisone. There were no maternal deaths. Maternal complications included preeclampsia in one and graft rejection in two. There were four live births (80%) with a mean gestational age of 33+3 (27+6 - 37+3) weeks. There were no fetal anomalies or cases of growth restriction, but two preterm births, one from spontaneous labor at 27+6 weeks and the other from labor induction for preeclampsia at 34+2 weeks. The infant delivered at 27+6 weeks had no residual sequelae at four months post-term age. Three women (75%) had caesarean deliveries for obstetric indications.

CONCLUSION:
With appropriate multidisciplinary care, women with cardiac transplants can have successful pregnancies. Although rates of fetal loss and congenital malformations are low on current immunosuppressive regimens, women may continue to be at risk for preterm birth.
Pregnancy Outcomes in Underweight Versus Ideal Weight Women at Time of Delivery [33F]
Authors: Gennette Sarah , Varlamov Anna , Eason Ron 
Published: May 2017

INTRODUCTION:
Maternal pre-pregnancy body mass index (BMI) and gestational weight gain are factors influencing neonatal birth weight. Underweight women have a higher risk of spontaneous preterm birth and small for gestational age infants. Whether underweight women at the time of delivery have the same risks, regardless of pre-pregnancy weight and weight gain during pregnancy, has not been reported for our region.

METHODS:
Ideal weight was defined as a BMI greater than 18.4 and less than 25. Underweight was defined as a BMI less than 18.5. The pre-pregnancy weight and weight gain were not included. This was a retrospective study of all deliveries at our hospital from 12/14/2009 to 10/1/2013 greater than 23 weeks. There was a total of 45,961 singleton deliveries. Thirty-six women were underweight versus 5,343 women considered ideal weight at the time of delivery.

RESULTS:
Major demographic variables were similar between the groups. Rates of preterm birth were higher in the underweight group (P < .05). Rates of induction of labor were higher in the ideal weight group (P < .05). There was no difference in cesarean section rates, Apgar’s, or cord pH. The neonatal birth weight was significantly smaller for the underweight patients (P < .05). However, the rate of NICU admissions was significantly higher in the underweight group vs the ideal weight (P < .05).

CONCLUSION:
Maternal weight at birth has the same implication on prematurity and low birth weight as maternal pre-pregnancy weight when underweight women are compared to ideal weight women.
Impact of Posterior Tibial Nerve Stimulation in Treatment of Refractory Overactive Bladder Syndrome [3G]
Authors: Carr Danielle , Kurdoğlu Zehra , Kurdoğlu Mertihan , Kilic Gokhan 
Published: May 2017

INTRODUCTION:
Overactive bladder (OAB) affects approximately 16% of adults in the United States. Posterior tibial nerve stimulation (PTNS) is the least invasive form of neuromodulation to treat OAB after failure of conservative therapies. In this study, we aimed to evaluate the impact of PTNS on OAB syndrome.

METHODS:
A retrospective study was conducted in Urogynecology Clinic between 2013 and 2016. Inclusion criteria consisted of female gender, documented clinic visit during the year before first PTNS, and completion of 12 weekly treatments. Medications used within the year before PTNS and at last follow up after PTNS were recorded. Symptom severity at first PTNS visit and after completion of PTNS was collected. Episodes of urinary frequency, leakage, and nocturia were recorded in discrete values. Urgency was reported subjectively using a scale from 1-4, with 4 being most extreme. The Wilcoxon Signed Rank Test was used for comparisons of symptom severity.

RESULTS:
Sixty patients in the clinic were identified with refractory OAB. Of the 46 patients receiving PTNS, 24 met inclusion criteria. Mean age was 70.25 ± 1.11 years. Mean follow up was 9.42 months. 54.17% did not require pharmacotherapy after completion of PTNS. The number of urgency episodes decreased from 3.12 to 1.79 (p=0.001), daytime frequency decreased from 7.29 to 5.58 (p=0.002), nocturia decreased from 3.33 to 2.17 (p=0.01), and leakage decreased from 2.62 to 1.33 (p=0.002).

CONCLUSION:
In this single center study, refractory OAB bladder responding to PTNS is slightly greater than 50% in selected patients, which agrees with the literature.
Correlation Between Sexual Function and Strength of the Pelvic Floor Muscles in Women With Dyspareunia [6G]
Authors: Carvalho Hellen B. , Macedo Lorena C. , Vasconcelos Danilo A. , Amorim Melania M. , Katz Leila 
Published: May 2017

INTRODUCTION:
Dyspareunia is defined as persistent or recurrent genital pain that occurs just prior to, during or after sexual intercourse, causing intense suffering or interpersonal conflict. Evaluating sexual function and strength of the pelvic floor muscles represents an important element when assessing dysfunctions such as dyspareunia.

METHODS:
A cross-sectional study involving 50 sexually active women of 18-35 years of age, 25 with dyspareunia and 25 without dyspareunia. Questionnaires were used to obtain the eligible women’s biological, sociodemographic and urogynecological characteristics. The Female Sexual Function Index was used to evaluate sexual function. Clinical evaluation of the pelvic floor was conducted to verify the presence of perineal contraction, with dynamometry being performed immediately afterwards. The Shapiro-Wilk and Mann-Whitney tests were used in the statistical analysis, together with Spearman’s rank correlation coefficient. Significance was established as 5%.

RESULTS:
Dynamometric measurements of superficial (p=0.01) and deep muscle strength (p=0.04) during pelvic floor muscle contraction were also lower in the dyspareunia group. A fair positive correlation (r=0.382; p=0.03) between the pain during sexual intercourse domain and dynamometric measurements of superficial muscle strength.

CONCLUSION:
A reduction was found in the dynamometric measurements of pelvic floor muscle strength in women with dyspareunia compared to those without dyspareunia and a correlation was found between pain and dynamometric measurements of superficial muscle strength.
SNS Retention Rates in the Treatment of Refractory OAB, Urinary Retention, and Idiopathic Fecal Incontinence [7G]
Authors: Hamouie Angie , Ünlü Serdar , Kilic Gokhan 
Published: May 2017

INTRODUCTION:
Sacral nerve stimulation (SNS) has proven to be an effective treatment of refractory overactive bladder (OAB), urinary retention, and idiopathic fecal incontinence. Many studies assessing the effectiveness of this treatment, however, often focus on the short- to medium-term effectiveness (less than 24 months) with a few studies extending up to five years. The purpose of this study is to determine whether patients continue to retain SNS 5 years after implantation.

METHODS:
This study was performed using health insurance claims data from Clinformatics DataMart. Data were collected between January 1st, 2002 and September 30th, 2014. Diagnoses and procedures were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification and Current Procedural Terminology codes. Data were initially screened for patients who had completed SNS implantation (n=2248). Inclusion criteria included women aged 18-65 who had had continuous insurance enrollment in the prior year (n=1231). Patients were excluded if they had had procedures associated with SNS treatment in the prior year (n=884). For each year, we assessed the number of patients who still had the SNS implant compared to the number of patients who had the SNS implant removed during follow-up.

RESULTS:
At year one, 85.8% of patients had retained the SNS implant (549/640). At year two, 81.4% (341/419). At year three, 78.1% (210/269). At year four, 79.0% (124/157). And at year five, 72.0% (67/93).

CONCLUSION:
The retention rate for SNS as a treatment for refractory OAB, urinary retention, and idiopathic fecal incontinence continues to be high at five years follow-up.
Diagnosis and Treatment of Positive Urine Cultures in Women With Pelvic Organ Prolapse [8G]
Authors: Solouki Shirly 
Published: May 2017

INTRODUCTION:
UTIs are one of the most common complications of Pelvic organ prolapse. The rate of urinary tract infections in patients prior to undergoing pelvic organ prolapse surgery is reported to be between 9.5-14%. The hypothesis of this study is that clean catch is a less accurate collection method in women with advanced pelvic organ prolapse.

METHODS:
A retrospective chart review of all women presenting to a single outpatient Urogynecologic center at NSLIJ for pelvic organ prolapse surgery between January of 2012 and December of 2015 was conducted. Inclusion criteria: female patients scheduled for surgical management of symptomatic pelvic organ prolapse with objective prolapse on Pelvic Organ Prolapse Quantification (POPQ) system. Exclusion criteria included active urinary tract infection, and symptomatic urinary tract infection.

RESULTS:
Charts were reviewed for 593 patients. A total of 550 patients met inclusion criteria. Of the 550 patients, 222 (40.36%) specimens were obtained by midstream clean catch and 319 (58.00%) by straight catheterization. When comparing mid-stream clean catch versus straight catheterization, there was a significant association between method of urine culture and urine culture result (P < 0.0001). There was a significantly greater number of positive cultures in specimens obtained via clean catch versus catheterization 60/231 (25.2%) vs 32/319 (10.0%), p < 0.0001). 76/231 (32%) of clean catch specimen had some growth or contamination.

CONCLUSION:
Altered anatomy of women with POP may affect their ability to provide a proper clean catch sample. This may lead to overtreatment of women with antibiotics. Straight catheterization may be more specific.
Financial Impact of Percutaneous Tibial Nerve Stimulation (PTNS) Treatment [10G]
Authors: Harmouche Jihad , Kurdoğlu Zehra , Kilic Gokhan 
Published: May 2017

INTRODUCTION:
To estimate average quarterly medication and physician visit costs for patients with refractory overactive bladder, before and after 12 sessions of Percutaneous Tibial Nerve Stimulation (PTNS) treatment.

METHODS:
This is a retrospective case series for patients undergoing PTNS for the treatment of refractory overactive bladder. 23 patients had 12 weekly sessions of initial PTNS treatment; 18 met the criteria for 3-month follow-up before and after treatment. Number of follow-up visits, PTNS maintenance visits, and medications were collected quarterly for a year before and after treatment. Using known medication and visit costs, we calculated mean quarterly costs, and standard deviations for patients, and measured their significance using a 2-tailed paired t-test.

RESULTS:
The average quarterly medication cost decreased from $656.40 ±292.45 to $375.51 ±331.80 after PTNS (p=0.01). The average number of quarterly provider follow-up visits decreased from 1.34 ±0.78 to 0.40 ±0.63 (p=0.001). The average quarterly total provider cost was calculated using the cost of follow-up visits in addition to PTNS maintenance visits. The average quarterly total provider cost increased from $136.96 ±81.50 to $ 181.04 ±146.34 (p=0.286). However, the total provider cost for the last quarter decreased from $169.04 ±103.69 to $55.14 ±94.62 (p=.005).

CONCLUSION:
PTNS treatment significantly reduced the average quarterly cost of medications and the average number of provider follow-up visits on patients with refractory overactive bladder. The average total provider cost initially increased in the first three quarters following PTNS and decreased the last quarter due to a higher number of PTNS maintenance visits immediately after treatment.
Moms in Medicine: Factors Associated with Job Satisfaction Among Physician-Mothers in Obstetrics & Gynecology [11G]
Authors: Gibbins Karen J. , Heuser Cara C. , Herrera Christina A. , Theilen Lauren H. , Holmgren Calla M. 
Published: May 2017

INTRODUCTION:
Physician satisfaction is linked to improved patient outcomes. While the proportion of physicians who are also mothers is increasing, little information is available regarding the impact of motherhood on physician satisfaction. Our study aims to assess factors that affect physician satisfaction among ob/gyn physicians who are also mothers.

METHODS:
We constructed and validated a Redcap survey and invited members of an online ob/gyn-mom group to participate. Characteristics of participants’ professional and personal lives were evaluated for possible association with the satisfaction outcomes. These characteristics were reported as frequency (%) or mean (standard error). Comparison testing was performed using Chi-squared test or Fisher’s exact test for categorical variables, Student’s t-test for parametric variables, and Wilcoxon Rank-Sum test for non-parametric variables.

RESULTS:
Responses were received from 232 participants. Women who rated their morale as very or somewhat positive worked fewer hours per week than women who with neutral or negative responses (43.6 vs 49.7, p=0.01). Women with positive morale were also less likely to work over 50 h/week (39.5% vs 56.8%, p=0.04). Women who said they would chose medicine again as a career were more likely to have a physician-spouse (29.8% vs 7.7%, p=0.01) and were more likely to use a nanny/au-pair for childcare (45.1% vs 13.9%, p=0.01). Longer clinical hours, especially over 50 h/week, correlated with dissatisfaction regarding time spent with children, spouse, and on personal activities.

CONCLUSION:
Longer clinical hours strongly correlate with personal and professional satisfaction based on several measurements. Spouse occupation and childcare method may also contribute to satisfaction.
The Second Victim: Can We Identify Those Most At Risk? [18G]
Authors: Benham Joshua , Liebermann Joan , Gaba Nancy , Amdur Richard , Margulies Samantha , Keller Jennifer 
Published: May 2017

INTRODUCTION:
Maternal and perinatal deaths impact those providing care to these patients (“second victims”). Limited research exists to determine who is likely to experience post traumatic stress disorder (PTSD), depression or anxiety after a maternal or perinatal death.

METHODS:
A survey was distributed by email to all Women’s Services staff (including Neonatal ICU) at an urban university hospital. The survey asked about experiences with perinatal and maternal death and included questions from validated screening tools for PTSD (PC-PTSD) and depression (PQH4).

RESULTS:
There were 105 responses to the survey. 43 of the responders were physicians. The remaining responders were midwives, nurses, techs and administrative staff. A multivariate model was used to test the independent association of predictors with outcomes and was used to develop prediction models. Four variables were predictive of a “negative outcome” (defined as experiencing anxiety, depression, post-traumatic stress symptoms, or work problems). These included: (1) a non-physician role, (2) substance use, (3) career change consideration, and (4) seeking mental health treatment after an event. With each additional risk factor, the negative outcome score increased significantly. Age, sex, religious beliefs, marital or parental status, and level of clinical involvement with patient/baby were not significantly correlated with negative outcomes.

CONCLUSION:
When providing support for team members involved in a maternal or perinatal death, individuals at risk for PTSD, anxiety, depression and work related problems should be identified and supported. Future studies will focus on the best way to assist those impacted by these events.
Social Media Etiquette Among Healthcare Professionals [20G]
Authors: Davis Jay , Folse Katherine , Billiot Angelle , Bissonnette Rosella , Hagan Joseph , Stafford Irene 
Published: May 2017

INTRODUCTION:
Social media (SM) use among healthcare professionals (HCPs) has skyrocketed. It is uncertain whether HCPs, including medical students, residents, and attending physicians, are aware of appropriate SM conduct. This study was conducted to survey HCPs on SM practices and knowledge of SM policy.

METHODS:
A survey was conducted among HCPs pertaining to SM usage that included reasons for use and applicable policy. The chi-square test was used to compare different occupations’ proportion of SM use, awareness of the AMA policy regarding SM and the proportion having received lectures regarding appropriate use. SAS version 9.4 was used for analysis. A 5% significance level was used for hypothesis tests.

RESULTS:
Six hundred forty-six participants responded: 524 (81%) medical students, 91 (14%) residents, 25 (4%) attending-physicians, and 6 (1%) unknown. Ninety-eight percent of participants stated they used SM. Only 33% were aware of the AMA SM policy and 43% received prior education on SM usage. The proportion of respondents reporting that they use SM more than 2 hours per week differed significantly by occupational group (p = 0.002) with attendings least likely to do so (41% compared to 71% for all others). A significantly smaller proportion (p < 0.001) of students(28%) were aware of the AMA policy compared to residents(56%) and attendings(63%). Students were also less likely (p < 0.001) to have received lectures regarding appropriate SM use compared to residents(64%) and attendings(54%).

CONCLUSION:
Our study demonstrated that medical students were more likely to use SM but were least likely to receive information on SM policy, a potential gap in medical education.