bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of Quality of Care Amongst Gestational Diabetic Patients in Community Hospital [16N]
Authors: Ake-Uzoigwe Rukeme , Sanusi Ayodeji , Salafia Carolyn , Zhang Dongping , Akinnawonu Kolawole , Fuks Aleksandr 
Published: May 2017

INTRODUCTION:
The objective of our study was to determine factors that affect the quality of care received by a gestational diabetic patient.

METHODS:
A retrospective cohort study of gestational diabetic patients' who delivered from January 2013 to December 2015. Patients were given quality scores based on predefined quality of care parameters. Patients were then categorized into high quality vs low quality care based on their quality score. Logistics regression analysis was used to determine the relationship between quality of care and variables of interest.

RESULTS:
Of 514 eligible patients, 468 (91%) had high quality care and 46 (9%) had low quality care. The predictors of High quality of care are: GDMA type: Medication vs Diet Control (OR: -5.74, p = < 0.001); Sex of Infant: Male vs Female (OR:- 0.74, p = 0.352); Age: 20-35 yrs vs less than 19 yrs (OR: 5.2, p= 0.062) and Greater than 35 yrs vs 19 yrs (OR: 5.2, p= 0.071).Gestational age at Diagnosis of GDM: 24 – 30 wks vs less than 24 weeks (OR:0.42, p= 0.16) and greater than 30 wks vs less than 24 wks (OR: 0.17, p = 0.001).Gestational age at initiation of prenatal care: greater than 24 wks vs less than 24 wks (OR: 0.46, p=0.023).

CONCLUSION:
Patients on medication control, who had an early diagnosis of gestational diabetes and who initiated prenatal care early were more likely to have high quality. Early initiation of prenatal care and prompt diagnosis of GDM is beneficial to improving quality prenatal care.
Preferences of Pregnant Women for Outcomes Related to Epilepsy and the Use of Antiepileptic Medications in Pregnancy [18N]
Authors: Wuebbolt Danielle , Nguyen Vanessa , Thomas Hannah , Bui Esther , Murphy Kellie , D'Souza Rohan 
Published: May 2017

INTRODUCTION:
Women with epilepsy are at risk of higher seizure-frequency in pregnancy and fetal malformations from the use of antiepileptic drugs (AEDs). The trade-offs women are willing to make, to optimize pregnancy outcomes have not been determined. This study elicits preferences of pregnant women with and without epilepsy, for maternal and fetal health states related to epilepsy and the use of AEDs in pregnancy with a view to informing practice and research.

METHODS:
Cross-sectional study on pregnant women that had epilepsy or another chronic medical disorder requiring medications during pregnancy. Study participants were presented with seven vignettes related to epilepsy and the use of AEDs in pregnancy and asked to assign them values on a visual analogue scale, by the standard gamble and time trade-off methods. Utility values were presented on a scale of 0-100.

RESULTS:
52 pregnant women completed the interviews. The median age was 33 (29.5-35) years and the median gestational age was 30 weeks. The epileptic and non-epileptic groups had identical demographic characteristics. Utility values for combined maternal-fetal health states related to epilepsy and the use of AEDs was obtained by three methods, from women with and without epilepsy. There were no differences in utility values obtained between groups regardless of the method used.

CONCLUSION:
This study provides utility values for combined maternal-fetal health states related to epilepsy and the use of AEDs for use in decision analysis studies and suggests that these preferences could be obtained from pregnant women with any chronic medical disorder taking medications during pregnancy.
Impact of an Obstetrical Hospitalist Program on the Safety Events in a Midsized Obstetrical Unit [24N]
Authors: Morton Ashley , Decesare Julie , Bush Suzanne 
Published: May 2017

INTRODUCTION:
As internal medicine hospitalist programs were developed to address issues in medicine such as a need to improve quality, improve efficiency and decrease healthcare cost, obstetrical (OB) hospitalist models were developed to address needs specific to obstetrics and gynecology (OB/GYN). Though there is an increase of OB hospitalist model utilization in the U.S., there is currently no published studies available that report outcomes following the implementation of OB hospitalist programs. Our objective was to compare outcomes measured by occurrence of safety events prior to and after implementation of an OB hospitalist program in a mid-sized obstetrical unit.

METHODS:
Our regional obstetrical referral hospital has approximately 3500 deliveries per year. Safety events are regularly monitored and evaluated. Our full-time OB hospitalist program was implemented in October 2014, with continuous coverage of the labor and delivery (L/D) floor. Safety events from the pre-implementation period, July 2012-September 2014, were compared to the post-implementation period, October 2014-June 2016.

RESULTS:
From July 2012 through September 2014, 11 safety events occurred on the L/D floor. From October 2014 through June 2016, post-implementation, there was zero safety events associated with L/D.

CONCLUSION:
Full-time OB hospitalists provided patients with immediate evaluation, early recognition of critical clinical events, and provided management in high stakes clinical situations. While it has been speculated that implementation of an OB hospitalist model would be associated with improved maternal and neonatal outcomes, our regional obstetrical referral hospital demonstrated a significant decrease and elimination of obstetrical safety events following the OB hospitalist program implementation.
Pregnancy Outcome in the Morbidly Obese: Black Versus White [37N]
Authors: Gennette Sarah , Guzman Angela , Peart Mishka , Carlan Steve , Mcwhorter Jeannie 
Published: May 2017

INTRODUCTION:
Obesity during pregnancy is associated with multiple known maternal and perinatal risks and these risks increase with increasing degrees of obesity. Racial disparities in obstetric outcome are well documented. Whether these two risk factors together further increase the chances of a poor outcome have not been studied. The purpose of this study was to compare the obstetric outcome of singleton pregnancies in morbidly obese black versus morbidly obese white women.

METHODS:
Morbid obesity (MO) was defined as a BMI greater than 40 at the time of delivery. Race was self-identified and recorded on admission. This was a retrospective study of all deliveries at our hospital from 12/14/2009 to 10/1/2013, total singleton deliveries: N = 45,961. Grp 1= Black MO, N = 1,236. Grp 2= White MO, N = 1,384.

RESULTS:
Based on our data, the addition of black race to morbid obesity increases the chances of poor obstetric outcome in all important measured variables except Cesarean delivery, labor induction and macrosomia. NICU admission was higher (N= 128 v N=104), Cord pH lower (7.25 ± .08 v 7.26 ± .08) and birth weight lower (3103 ± 734 v 3383 ± 710 g) between Grp 1 and Grp 2, respectively, P less than .05.

CONCLUSION:
This study suggests that black MO pregnant women are at greater risk of poor obstetric outcome than white women possibly based on their race.
The Role of Residents in the Gynecologic Operating Room – What Do Patients Understand? [5O]
Authors: Cantor Arielle , Flood Cathy , Boutin Savanna , Regan Shauna , Ross Sue 
Published: May 2017

INTRODUCTION:
Studies in emergency medicine show that patients believe it is important to know the training level of their doctor, but most do not understand the responsibilities of physicians-in-training. No research on this topic has been published in gynecology, even though gynecological surgeons have been sued by patients alleging they did not understand the role of residents in their surgery. The goal of this research was to explore what gynecological surgery patients understand about the role of resident doctors.

METHODS:
A questionnaire was distributed to female patients in pre-admission clinics awaiting gynecological surgery in Edmonton. Surveys included knowledge and opinion-based questions about resident duties. Anonymous responses were entered into a REDCap database. Descriptive statistics were used to characterize the results.

RESULTS:
Of 108 participants, 83% understood that residents had a higher level of training than medical students, yet 40% were unsure if residents were doctors. Almost half (43%) were uncertain if residents required supervision, including while operating (20%). The majority (92%) felt it was important to know their physician's level of training, yet only 63% reported actually knowing this information. Only half of participants would be comfortable with residents operating on them under supervision. A considerable number (56%) wanted to learn more about residents' roles.

CONCLUSION:
Patients do not fully understand the role of residents and many are uncomfortable with trainees operating on them under supervision. Considering the significant role of residents in patient care, educating patients is essential to improve their comfort and the overall consent process.
Gender Disparities in Small Group Verbal Participation Among 1st Year Medical Students [9O]
Authors: Peterson-Perry Sylvia , Bohnett Mary Clare , Rabinowitz Molly , Peterson Mariah 
Published: May 2017

INTRODUCTION:
Gender disparities exist for female clinicians today, from limits on upward mobility to unequal pay and more. In non-medical education, it has been shown that in-class verbal participation correlates with academic success. Research is lacking on whether verbal participation disparities exist during preclinical medical education, and if they do, what the significance of this may be for female trainees and the educational climate.

METHODS:
This descriptive cohort study explores the extent to which gender disparities exist at the level of preclinical medical education, using the proxy metric of verbal participation in class. We aimed to (1) quantify any gender disparities in verbal participation in medical school small work groups, and (2) to examine whether factors such as facilitator gender or facilitation style impact female verbal participation. We collected covert observational data over a 4-week period during a 1st year basic science course. Ten small work group sessions were observed and unique verbal participation events were counted by gender. Facilitator gender, gender composition of group, and inclusionary comments by facilitator were also recorded.

RESULTS:
Descriptive statistics analysis revealed an imbalance in average verbal participation events between males and females of >2:1, even when adjusted for group composition and facilitator gender. At least one instance of inclusive facilitation per session increased female participation, but did not close this gap.

CONCLUSION:
Participation disparities exist. More research is needed to explore implications, as well as interventions by which gender equality can be promoted in the small work group microcosm and beyond.
Is 'Baby-Friendly' Actually 'Mommy-Friendly?' The Baby-Friendly Initiative and Effect on Patient Satisfaction [11O]
Authors: Ebinger Jessica , Castleberry Lauren , Cai Bo 
Published: May 2017

INTRODUCTION:
The Baby-Friendly Hospital Initiative was launched by the World Health Organization in 1991 to encourage breastfeeding. Baby-Friendly USA has specific criteria for “Baby-Friendly” designation. No studies have been reported about patient satisfaction; few show increased breastfeeding rates.

METHODS:
Patients aged 16 years or older that were cared for and delivered by the resident service were provided anonymous surveys during postpartum visits during a 4-month study period.

RESULTS:
145 of 170 surveys qualified for analysis. 28% underwent Cesarean delivery (CD); 72% vaginal delivery. 28% responded “neutral or disagree” when asked if they could rest and recover in the hospital. Compared to patients delivering vaginally, post-operative patients were more likely to respond negatively when asked if they felt they could safely care for their infant (P < .05). 97% reported being informed of infant safe sleeping guidelines; 84% practiced safe sleeping. 103 (72%) planned exclusive breastfeeding with 50% switching to some formula feeding at discharge. 40 patients planned to formula feed prior to delivery; 3 (7.5%) switched to exclusive breastfeeding. Of formula users, 35.7% felt inadequately informed about formula feeding; 26% felt shamed regarding their decision.

CONCLUSION:
Baby-Friendly policies can impact patient well-being and potentially infant safety. Patients undergoing CD and those who formula feed may need additional support caring for newborns and education not addressed by Baby-Friendly. Though most patients planned to breastfeed, half switched to some formula feeding upon discharge. Many felt shamed regarding their decision or inadequately educated on formula feeding. This small study suggests additional research is needed.
Instrumental Vaginal Delivery in Abakaliki, South-East Nigeria. [17O]
Authors: Ozumba Benjamin , Ajah Leonard O. , Iyoke Chukwuemeka A. , Mamah Emmanuel J. , Asiegbu Obiorah G. 
Published: May 2017

INTRODUCTION:
Instrumental vaginal delivery is used as an alternative to caesarean section especially in this environment with high aversion to caesarean section. This study aimed at determining the rate and perinatal outcome of instrumental vaginal deliveries in Abakaliki, South-East Nigeria.

METHODS:
This was a 5 year retrospective study in which case files of instrumental deliveries at Federal Teaching Hospital, Abakaliki from January 1,2011 to December 31,2015, were retrieved. The data on age, parity, booking status, type of instrumental delivery performed, Apgar scores of neonates delivered and complications were analyzed with SPSS software for Windows version 16.

RESULTS:
A total of 304 out of 11,649 deliveries were delivered with the aid of instrumental delivery. Therefore the instrumental delivery rate was 2.6%.The vacuum and forceps delivery rates within the study period were 2.6% (302/11649) and 0.02% (2/11,649) respectively. The perinatal mortality was 6.6% (20/304). There was an annual decreasing trend of instrumental delivery.

CONCLUSION:
The instrumental delivery rate especially forceps in Abakaliki is very low. This is worrisome in an environment with aversion to caesarean section. Therefore efforts should be geared towards training and retraining of doctors on this skill.
Effects of Amniotic Fluid Index on Perinatal Outcomes in Preterm Premature Rupture of Membranes [37O]
Authors: Ladella Subhashini , Leung Teresa , Cortez Cynthia 
Published: May 2017

INTRODUCTION:
Amniotic fluid has antibacterial properties and a protective effect on the fetus. A decrease in amniotic fluid index (AFI) during pregnancy has been associated with increased risk for adverse perinatal outcomes. Prior studies have shown a low AFI of less than 5 cm to be associated with a shorter latency period, however, its association with increased risk of perinatal infection has been unclear. The purpose of this study is to determine if AFI levels in women with preterm premature rupture of membranes (PPROM) are associated with adverse perinatal outcomes.

METHODS:
A retrospective cross sectional study was performed at Community Regional Medical Center in Fresno, CA on women with diagnosis of PPROM between gestational ages of 23 to 34 weeks during 6/1/2014 to 6/1/2016. The primary predictor variable was AFI level less than 5 cm and greater than 5 cm in relationship to perinatal outcomes.

RESULTS:
A total of 117 PPROM cases were reviewed, 46 women had an AFI less than 5 cm and 71 women had an AFI greater than 5 cm. Length of stay in NICU was 42 days with AFI less than 5 cm versus 26.5 days with AFI greater than 5 cm (P < .013).

CONCLUSION:
AFI greater than 5 cm in PPROM is associated with decreased length of stay in the NICU. No significant difference was found between AFI levels and latency period. Further data is needed to increase the power of the study. Research is being done to investigate the association of AFI less than 5 cm with decreased latency period and increased adverse pregnancy outcomes.
Differences in Patient and Provider Views on Gestational Weight Gain and Exercise Counseling During Pregnancy [10E]
Authors: Delgado Arlin , Stark Lauren , Macri Charles J. , Schulkin Jay 
Published: May 2017

INTRODUCTION:
Appropriate gestational weight gain (GWG) during pregnancy impacts the health of a mother and child long after birth, yet reports show only one third of women nationwide achieve this. Current literature documents a patient‒provider communication gap is associated with incorrect GWG. The purpose of this survey study was to assess provider and patient views on current office practices and suggested educational tools about GWG and exercise during pregnancy.

METHODS:
Providers and patients at a major urban OB/GYN clinic were recruited for a voluntary survey. Descriptive statistics of responses were run and compared.

RESULTS:
A total of 461 patient and 36 provider responses were analyzed. All providers reported discussing GWG with patients at least once; however, 76.1% of patients recalled any GWG discussion and even less recalled discussing personal GWG recommendations (53.4%). Providers and patients similarly recalled discussing exercise during pregnancy. Providers reported distributing pamphlets/brochures/flyers for GWG (60.0%) and local resources for exercise (43.8%) much more than patients reported receiving (30.6% and 6.5%, respectively). Patients perceived suggested educational tools much more useful than providers, the largest gaps among placing GWG and exercise informative posters in the exam and waiting rooms.

CONCLUSION:
The gap among patients and providers suggests current clinical practices should be improved to better healthcare. Patients may expect GWG and therefore are unaware of the negative health impacts, while providers are trained in these outcomes, thus explaining reported office differences. Future research should study if implementing tools, especially in exam and waiting rooms, would increase practice efficacy.
Prevalence of Abnormal Pap Smear in Women Undergoing Liver Transplantation [15E]
Authors: Threadcraft Marcus , Guha Paulami , Wells Ali , Dinh Tri , Nguyen Justin , Harnois Denise 
Published: May 2017

INTRODUCTION:
Female patients being evaluated for liver transplantation (LT) routinely undergo a gynecologic exam including cervical cancer screening. The prevalence of cervical cytologic abnormalities in this high risk population is unknown. Our study determines prevalence of cervical cytologic abnormalities, HPV positive status, and risk factors for abnormal cervical screening for this population.

METHODS:
With Institutional review board approval, we reviewed 375 charts of women undergoing evaluation for LT from 2008‒2013 at Mayo Clinic Florida. We recorded demographics, Pap smear results, High risk HPV positive results, and co-morbid conditions. Univariate analysis was done to determine risk factors. We compared the result of the LT group to the general female population getting cervical cancer screening during the same time period.

RESULTS:
37 of 375 (9.86%) LT patients had abnormal Pap smear, compared to 1784 of 26118 (6.83%) of the general population patients (p < 0.01). Among LT patients with cervical cytologic abnormalities, 40.5% were ASCUS, HPV positive (64.8% for non-LT patients), 29.7% were LSIL (28.1% for non-LT patients), 5.4% were HSIL (6.7% for non-LT patients) and 24.3% were cytology negative with HPV positive (0.2% for non-LT patients, p < 0.05). Younger age and presence of hypertension were associated with higher risk of having an abnormal cervical cytology or positive HPV status among LT patients.

CONCLUSION:
Patients undergoing evaluation for LT have increased prevalence of abnormal cervical cytology, or a positive High risk HPV test. Gynecologic surveillance for this high risk population is recommended.
A Coordinated Cultural Shift Improves Breastfeeding Exclusivity in a Federally Qualified Health Center [16E]
Authors: Stechna Sharon , Miller Ralee , King LaShonda 
Published: May 2017

INTRODUCTION:
Provider support for breastfeeding has been shown to have a positive impact on breastfeeding including initiation and continuation. This study attempts to determine if a coordinated cultural shift can influence breastfeeding rates among patients in a Federally Qualified Health Center (FQHC).

METHODS:
All staff at Eric B. Chandler Community Health Center, an FQHC located in an urban setting in New Jersey, were educated about the importance of breastfeeding and improved outcomes in breastfeeding mother-baby pairs. Additionally, key staff members were trained to assist with breastfeeding problems. Breastfeeding promotion was standardized within the obstetric program. A professional relationship with WIC was established. Data was collected and analyzed to determine if there was an impact on breastfeeding at the six-week postpartum visit comparing the six months prior to and six months after the cultural shift.

RESULTS:
Three hundred seventy-three women in the post intervention group were compared to 63 women in the baseline group. Exclusive breastfeeding at six weeks postpartum increased from 12/63 (19.1%) to 107/373 (28.7%), p less than 0.05. Combination feeding decreased from 31/63 (49.2%) to 159/373 (42.6%). Exclusive formula feeding remained unchanged 20/63 (31.7%) compared to 107/373 (28.7%). Mode of delivery had no influence on rates of breastfeeding.

CONCLUSION:
This study demonstrates that a coordinated cultural shift can increase the rate of breastfeeding exclusivity in a FQHC. Improvement in exclusivity, however, was a result of more breastfeeding women forgoing supplementation. There was no comparable increase in formula feeders choosing either combination feeding or exclusive breastfeeding.
The Effect of Ultrasound Findings on the Risk of Aneuploidy With a Positive Cell Free DNA Screen [17E]
Authors: Rich Gabrielle , Maher James , Kelly Randall , Kodeih Hanna , Schlabritz-Lutsevich Natalia 
Published: May 2017

INTRODUCTION:
Cell free DNA (cfDNA) is the newest addition to prenatal screening. Its benefits include that it has a superior sensitivity and specificity and can be performed earlier in pregnancy. However, its use in a low risk population is controversial due to the lower prevalence of aneuploidy and the need for additional evaluation.

METHODS:
We performed a retrospective review of data from unexpected positive cfDNA with a normal ultrasound. We compared the karyotype information from this cohort with a high risk cohort where cfDNA was prompted by an abnormal ultrasound finding.

RESULTS:
48 cfDNA were performed for ultrasound anomaly. 14 of these were positive with a confirmed abnormal karyotype. There was a 29% risk of aneuploidy in this cohort. In 105 patients with a normal ultrasound, all had normal cfDNA and no post-natal abnormalities reported. 7 patients had positive cfDNA prior to ultrasound. All 7 cases had a normal ultrasound and a confirmed normal karyotype. Using Fishers exact test, the probability of an abnormal karyotype following a positive cfDNA was lower with a normal ultrasound. (p=0.0035). Phi coefficient for association = 0.39. (p=.0001).

CONCLUSION:
A positive cfDNA presents a challenge in counseling low risk patients. Best practice dictates invasive testing for confirmation of the cfDNA results. Our findings suggest that a normal ultrasound after a positive cfDNA is associated with a significantly reduced prevalence of aneuploidy. This information may be reassuring to women who decline invasive testing.