bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Multi-Modal Approach to Increasing Knowledge and Comfort of OBGYN Residents in Pelvic Organ Prolapse [5G]
Authors: Zyman Mark , Yuan Valerie , Liao Christina , Navas John , Yazdany Tajnoos 
Published: May 2017

INTRODUCTION:
Nearly 46% of Obstetrics and Gynecology (OBGYN) residents feel unsatisfied with their Female Pelvic Medicine and Reconstructive Surgery (FPMRS) training. Residents in 85% of residency programs can satisfactorily perform four of ten basic FPMRS procedures at graduation. We describe implementing a multi-modal and interactive intervention to improve resident knowledge and comfort with counseling and treating patients with pelvic organ prolapse (POP).

METHODS:
Using VAS scales and multiple choice questions, we assessed the knowledge and comfort levels of managing basic POP among all OBGYN residents during the 2014-2015 academic year. Each resident underwent a 45 minute didactic involving multi-media training modules using the Boston Scientific Pop-Q application and a high-yield POP lecture prior to their FPMRS rotation. The same exam was given four months after completing the rotation.

RESULTS:
Of 19 residents enrolled, 18 completed the study. Comfort levels increased by 18.7% (P < 0.01). The pre and post-intervention mean scores were 383 and 533 points with a mean change of 150 (P<=0.01). POP knowledge scores increased by 9.6% (P < 0.05). The pre and post-intervention mean scores were 2.88 and 3.55 points with a mean change of 0.67 (P < 0.05). The intervention was well received and requested to be implemented into the curriculum.

CONCLUSION:
A high yield, multi-modal didactic immediately prior to immersion in patient care significantly improved knowledge, satisfaction and comfort level of POP, regardless of resident training level. This was retained even after completion of the rotation. Educational efforts for basic FPMRS topics should be multi-modal to enhance OBGYN resident knowledge and comfort levels.
Determinants of Ethical Concern With Multifetal Pregnancy Reduction Among U.S. Women of Reproductive Age [17G]
Authors: Lim Esther , Collins Stephen C. 
Published: May 2017

INTRODUCTION:
Multifetal pregnancy reduction (MFPR) is recognized by the American College of Obstetricians and Gynecologists and the American Society of Reproductive Medicine to be a challenging ethical decision. This study explores the determinants of ethical concern with MFPR among U.S. women of reproductive age.

METHODS:
Data were obtained from the National Survey of Fertility Barriers (Wave 1, 2004-2007), a random digit dialing telephone survey of 4,794 women aged 25-50. Logistic regression was performed to determine the relationship between ethical concern with MFPR and religion, obstetric history, history of infertility, and history of infertility treatments.

RESULTS:
Only 14.7% of respondents had no ethical concerns with MFPR, while 44.3% expressed serious concerns. Serious ethical concerns were less likely among women with a history of abortion (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.31-0.58) or with no religious affiliation (OR 0.47, 95% CI 0.31-0.70). Serious ethical concerns were more common among women with a history of multiple gestation (OR 3.30, 95% CI 1.44-7.56) or who attend a weekly religious service (OR 1.55, 95% CI 1.16-2.08). After adjustment, religiosity remained a significant determinant of having serious ethical concern with MFPR (OR 1.18, 95% CI 1.12-1.24). History of infertility and its treatment had no significant association with ethical concerns about MFPR.

CONCLUSION:
A majority of U.S. women have ethical concerns with MFPR. While religiosity is a significant determinant of this concern, infertility and infertility treatments are not. The overall high level of ethical concern with MFPR underscores the importance of minimizing multiple gestations during infertility treatment.
Factors Associated With Dissatisfaction Among Obstetricians and Gynecologists in the United States [19G]
Authors: Cha Sandolsam , Smith Heather A. , Atallah Fouad , Chalas Eva , McCalla Sandra , Goffman Dena 
Published: May 2017

INTRODUCTION:
There is growing concern about physician burnout and dissatisfaction. Characterizing sociodemographic and practice-environment characteristics associated with dissatisfaction among obstetricians and gynecologists (OB-GYNs) can aid in developing mechanisms to better support physicians and promote wellness.

METHODS:
A 24-question survey querying sociodemographic and practice-related information was electronically distributed nationally to board-certified OB-GYNs. The primary outcome was dissatisfaction in clinical and personal domains. Univariate analyses were performed using chi-squared/Cochran-Mantel-Haenszel statistics, and multivariable by logistic regression.

RESULTS:
Of the 5005 respondents, 28.9% were dissatisfied with clinical workload and 35.5% with their ability to meet personal responsibilities. Following regression, factors associated with dissatisfaction in 3 or more domains include: female gender (Adjusted Odds Ratio (aOR) 1.50, 95% Confidence Interval (CI) 1.31-1.72), required call-shifts (aOR 1.18, 95% CI 1.04-1.34), more than 45 clinical hours weekly (aOR1.54, 95% CI 1.35-1.75), less than 6 hours of sleep nightly (aOR1.68, 95% CI 1.48-1.92), experience of major fatigue-related consequences (aOR5.99 95% CI 4.63-7.75), and work-related stress (aOR 4.2, 95% CI 3.0-5.7). Protective factors include laborist practice (aOR 0.50, 95% CI 0.35-0.74) and receipt of incentive-pay in addition to base salary (aOR 0.82, 95% CI 0.69-0.96). Among respondents who reported fatigue-related consequences, factors associated with resilience against dissatisfaction include being married (aOR 0.71, 95% CI 0.59-0.85) and practice-designs of laborist (aOR 0.46, 95% CI 0.32-0.67) or small private group (aOR 0.70, 95% CI 0.57-0.85).

CONCLUSION:
Identifying individuals or populations at increased risk for dissatisfaction can help development of interventions on both individual and systems-level, and provide insight into enhancement of future practice designs.
Improving Provider Readiness for Intimate Partner Violence Screening [35G]
Authors: Lee Amy S. D. , McDonald Lynn , Wahab Maybel , Will Susan , Lee Judy M. , Coleman Jenell 
Published: May 2017

INTRODUCTION:
Intimate Partner Violence (IPV) is a significant public health issue. Around 30% of American women yearly experience IPV with a lifetime incidence as high as 50%. An interprofessional team collaborated to increase and standardize IPV screening of women presenting for outpatient obstetric and gynecologic care through integration of a validated IPV screening tool into the electronic medical record (EMR).

METHODS:
The team evaluated provider readiness for IPV screening pre- and post- intervention through the use of The Domestic Violence Health Care Provider Survey Scale (DVHCPSS). An intervention was implemented that included the EMR integration of a validated IPV screening tool, the creation of an automated resource telephone system, and the education of providers regarding screening and response. The DVHCPSS is scored cumulatively for an overall score and may also be divided into six interest areas. Pre- and post-intervention DVHCPSS scores were compared using an independent Student t-test.

RESULTS:
Mean age (31 to 40) and years of clinical practice (11 to 15) was the same for both pre- and post-intervention survey respondents. There was an overall significant improvement in provider readiness (P=.003) with specific areas of significant improvement in “Professional Role Resistance/Fear of Offending the Patient” (P < .0001), “Blame Victim Items” (P=.0029), and “Perceived Self Efficacy” (P=.0064).

CONCLUSION:
Adopting and integrating a validated IPV screening tool into the EMR paired with provider education was associated with an improvement in provider readiness for IPV screening. Ultimately, this aims to be a blueprint for IPV screening and referral across this community and others.
Microbial Profiles and Tumor Markers From Culdocentesis: A Novel Screening Method for Epithelial Ovarian Cancer [3H]
Authors: Candel Sofia , Karr Mallory , Brard Laurent , Thomson Jongjin Anne , Groesch Kathleen , Braundmeier-Fleming Andrea 
Published: May 2017

INTRODUCTION:
Epithelial ovarian cancer (EOC), the most prevalent type of ovarian cancer, has a low five-year survival rate because it is commonly diagnosed in later stages of disease. There is a critical need for early screening methods to improve mortality outcomes. Specific bacterial populations (microbiome) have been linked to various diseases but not investigated with EOC. We hypothesize that patients with EOC have a unique microbiome and this used in conjunction with tumor markers from culdocentesis and serum, would benefit EOC diagnosis and prognosis.

METHODS:
Study population includes women aged 30 or older, undergoing surgery for an adnexal mass or ovarian malignancy at two hospitals in Springfield, IL. Exclusion criteria are previous malignancy within last 5 years and inability to perform culdocentesis. On the day of surgery, serum and culdocentesis samples were analyzed for CA-125/HE4 concentrations while culdocentesis samples were also sequenced for bacterial V4 rDNA. Associations of microbial profiles with tumor marker levels will be calculated using models developed for biomarker discovery.

RESULTS:
Currently, 30 patients (10 EOC, 20 benign) have been analyzed for CA-125/HE4. Preliminary results showed elevated tumor markers in EOC serum and culdocentesis but higher EOC positive and negative predictive values in serum than culdocentesis. Microbial profiles recently identified will be correlated to sample tumor marker levels.

CONCLUSION:
Culdocentesis tumor marker levels significantly correlated with EOC although less than serum levels. Additional analysis of microbial profiles may advance current screening methods and personalized treatment strategies, potentially increasing survival rates of patients with EOC.
Robotic Versus Traditional Laparoscopy in Benign Hysterectomy: A Single Institution Experience [13H]
Authors: Friedman Caroline , Tierney Christina , Nasioudis Dimitrios , Fields Jessica , Zhou Zhen Ni , Holcomb Kevin 
Published: May 2017

INTRODUCTION:
Robotic-assisted laparoscopy in benign hysterectomy remains controversial, and current evidence suggests similar outcomes when compared to traditional laparoscopic hysterectomy. This study sought to compare clinical outcomes between the two types of procedures at a single academic institution.

METHODS:
The electronic medical records of 133 women treated with robotic hysterectomy (RH) and 69 patients treated with traditional laparoscopic hysterectomy (TLH) for benign indications between September 2011 and December 2014 were reviewed. Clinical outcomes were compared using univariate and multivariate analyses.

RESULTS:
Patients undergoing RH were older (median 57 vs 48 years, P < .001) and less likely to be obese (18.8 vs 34.8%, P=.017). Operative time was similar for RH and TLH (203.0 vs 204.5 minutes, P=.973), despite a higher rate of concomitant procedures in robotic cases (32.3 vs 7.2%, P < .001). TLH was associated with higher rates of conversion to laparotomy (11.6 vs 1.5%, P=.003), blood loss greater than 1,000 mL (5.8 vs 0.8%, P=.047), and hospital stay greater than 2 days (21.7 vs 7.5%, P=.004). There were no significant differences in intraoperative or postoperative complications between groups. Multivariate logistic regression controlling for body mass index and specimen weight found total operative time (P=.006), estimated blood loss (P=.002), and TLH (P=.04) to be independent predictors of conversion to laparotomy.

CONCLUSION:
In our population, robotic-assisted hysterectomy was associated with lower rates of intraoperative hemorrhage, conversion to laparotomy, and extended hospital stay when compared to traditional laparoscopy. Such data support the utilization of robotic assistance in laparoscopic hysterectomy for benign indications.
Phase 2 Study of Relugolix vs Placebo in Heavy Menstrual Bleeding Associated With Uterine Fibroids [17H]
Authors: Hoshiai Hiroshi , Seki Yoshifumi , Kusumoto Takeru , Kudou Kentarou , Komura Emiko , Tanimoto Masataka 
Published: May 2017

INTRODUCTION:
Relugolix is a potent nonpeptide gonadotropin-releasing hormone receptor antagonist. This dose-finding study explored the ability of relugolix to decrease the heavy menstrual bleeding (HMB) associated with uterine fibroids (UF).

METHODS:
This randomized, double-blind, placebo-controlled, phase 2 study was designed to evaluate relugolix 10 mg, 20 mg and 40 mg administered orally once daily for 12 weeks in Japanese women with UF and HMB defined as a Pictorial Blood Loss Assessment Chart (PBAC) score of at least 120. The primary endpoint was the proportion of women with a total PBAC score of less than 10 from Week 6 to 12. Secondary endpoints included the proportion of women with amenorrhea, and myoma and uterine volumes.

RESULTS:
Patients (N = 216) were randomized to placebo or one of three relugolix groups. The proportion of patients with PBAC score of less than 10 from Week 6 to 12 was 0% in placebo group, and 20.8%, 43.6% and 83.6% in relugolix 10 mg, 20 mg and 40 mg groups (P < 0.001 vs placebo).74% of patients in relugolix 40 mg group achieved amenorrhea, and a dose-dependent decrease in myoma and uterine volumes were observed. The incidence of headache, metrorrhagia, menorrhagia, and hot flush were more than 10% higher in relugolix 20 mg and 40 mg groups than in placebo group; these AEs were mild or moderate in severity.

CONCLUSION:
Treatment with relugolix showed significant dose-dependent decreases in menstrual blood loss compared with placebo and was generally well-tolerated with AEs consistent with the drug’s mechanism of action.
Trends in Hysterectomy After Cessation of Power Morcellation [19H]
Authors: Susla Lyudmyla , Brown Amy , Einstein Margaret , O'Sullivan David , Shafer Aaron 
Published: May 2017

INTRODUCTION:
In April 2014, the FDA issued a warning against use of power morcellators. Soon after, their use was banned at many hospitals, including Hartford Hospital. There have been numerous position statements for and against these bans. We sought to examine the effect of this ban on women undergoing hysterectomy at Hartford Hospital. We hypothesized a decrease in minimally invasive hysterectomy after the morcellator ban.

METHODS:
This was a retrospective cohort study of all women who underwent hysterectomy for benign indications at Hartford Hospital from May 2013 to April 2015. We grouped patients into those who had surgery before 5/1/14 (pre-ban) and those after 5/1/14 (post-ban). Excluded were those women undergoing hysterectomy for gynecologic malignancy or those undergoing surgery for utero-vaginal prolapse and/or incontinence.

RESULTS:
1082 women met all inclusion criteria; 578 had hysterectomy pre-ban and 505 post-ban. Power morcellation decreased from 12.6% pre-ban to 0.4% post-ban, p < 0.001. There was no difference in the percentage of open hysterectomies, 13.3% (77) pre-ban and 14.8% (75) post-ban, p=0.47. Supracervical hysterectomies decreased from 9.9% to 3.2% (p < 0.001). There was no increase in conversion to laparotomy (2.4% vs. 1.8%, p=0.47), use of “manual morcellation” (19.3% vs. 23.8%, p=0.12) in minimally invasive procedures, mean length of stay (1.3 vs. 1.2 days, p=0.20) or blood loss (151 vs. 163 mL, p=0.69). 2 leiomyosarcomas were found, both post-ban.

CONCLUSION:
While we do not disagree with many of the criticisms to the FDA’s morcellator ban, it has not led to a decrease in access to minimally invasive hysterectomy at our institution.
The Association Between Surgical Route and Perioperative Outcomes for Women Undergoing Myomectomy [25H]
Authors: Sappenfield Elisabeth , Miladinovic Branko , Sarkar Papri , Imudia Anthony , Mikhail Emad 
Published: May 2017

INTRODUCTION:
Fibroids are the most common solid pelvic tumor. Most symptomatic fibroids are managed surgically. The abdominal approach to myomectomy is more commonly performed than the laparoscopic approach. Primary objectives include examining the association between the route chosen for myomectomy and the 30-day perioperative outcomes for women undergoing the procedure.

METHODS:
Data for this retrospective review was obtained from the American College of Surgeons-National Surgical Quality Improvement Project database. Using Current Procedural Terminology. All women over the age of 18 years who underwent a myomectomy from 2005-2014 were included. A mixed-effects logistic regression analyses were performed to analyze the association between the route of myomectomy and 30-day perioperative outcomes, and to control for confounding factors including age, race, and fibroid weight.

RESULTS:
2,862 women underwent myomectomy; 1,207 were laparoscopic (42%) and 1,655 were open (58%). Laparoscopic myomectomy was less likely to be utilized for fibroids larger than 250 gm (45.9%) versus less than 250 gm (54.1%) [ORadj (95%CI)] [0.737 (0.575, 0.946)]. Laparoscopic myomectomy was associated with decreased length of hospital stay 0 d versus 2 d [ORadj (95%CI)] [0.143 (0.123, 0.167)], and longer operating times 157 m versus 116 m [ORadj (95%CI)] [1.014 (1.012, 1016)] compared to open myomectomy. There was no significant difference in readmission rate, postoperative urinary tract infection and pneumonia, and occurrence of deep vein thrombosis.

CONCLUSION:
Laparoscopic myomectomy was utilized less frequently for fibroids larger than 250 gm. Laparoscopic myomectomy was associated with a shorter hospital stay but a longer operative time.
The Accuracy of the Pelvic Exam Compared to Ultrasound and Pathology Measurements Based on Body Mass Index [28H]
Authors: Olsen Nina S. , Downing Perrin , Grasso Mackenzie , Murag Soumya , Truong Mireille 
Published: May 2017

INTRODUCTION:
The purpose of this study was to evaluate the accuracy of pelvic exam when compared to ultrasound measurements and pathology weight depending on BMI. To our knowledge, there are limited studies evaluating the effect of BMI on accuracy of bimanual examination and a more recent investigation is long overdue.

METHODS:
This was a retrospective chart review of patients over the age of 18 undergoing hysterectomy for benign indications between July 2010 and July 2015. Bimanual examination and ultrasound measurements of the uterus prior to surgery were compared to pathology weight and then their accuracy was compared based on BMI. Concordance correlation coefficients were used to estimate accuracy of these measurements. Bland-Altman plots were used to compare the weights from clinical exam and ultrasound to the actual pathology weight.

RESULTS:
981 records were reviewed, of those 364 met inclusion criteria. Average weight of the uterus was 454.04 gm (+/-475.27). Average age and BMI of women undergoing hysterectomy was 45.5 years (+/-7.5) and 31.65 (+/- 7.09) respectively. Overall concordance between the three different methods of estimating uterine size ranged from 0.73 to 0.82. Concordance did not differ significantly between different BMI categories.

CONCLUSION:
The findings of pelvic exam are similar to ultrasound measurements when compared to pathology weight regardless of BMI whenever the uterine size can be estimated. These results suggest that if uterine size can be assessed, ultrasound may not be necessary for preoperative evaluation.
Hysterectomy- Vaginal, Abdominal and Robotic Laparoscopic Study: Clinical Evaluation and Cost Analysis [29H]
Authors: Hanafi Magdi 
Published: May 2017

INTRODUCTION:
This study compared postoperative clinical outcome and hospital cost for Total Vaginal (TVH), Total Abdominal (TAH) and Robotic Laparoscopic (RLH) Hysterectomy.

METHODS:
Retrospective study for all hysterectomy cases from January 1st 2008‒December 31st 2015 performed by the author. Patients were divided into three groups: TVH, TAH and RLH. Postoperative clinical outcome surveyed by questionnaire. Data collected from the office and hospital electronic medical records and used to determine patient demographics, hospital stay, and operative time, estimated blood loss (EBL) and total hospital charges. A total of 333 patients were reviewed and 230 patient questionnaires were completed (69.06%).

RESULTS:
TAH had a significantly higher hospital stay of 2.8 days compared to TVH and RLH with 1.41 days. RLH had a significantly higher operative time (194.11 min) than TVH (119.75 min) and TAH (181.66 min). The EBL significantly higher in TAH (194.16 mL) than RLH (105.67 mL) and TVH (97.11 mL). No significant differences in hospital charges between TAH and RLH but both TAH and RLH had significantly higher total charges than TVH. TAH had a higher level of post-operative pain than RLH, no significant difference in pain level between other methods.

CONCLUSION:
A significantly higher hospital stays in TAH vs. all other methods. TAH and RLH had significantly higher hospital charges vs TVH. TAH had significantly higher in EBL than RLH. TAH had higher level of postoperative pain than RLH and TVH. The Learning curve has a significant impact on the operative time of RLH and subsequently it’s cost.
Narcotic Prescriptions for Benign Gynecologic Procedures in a Tertiary Care Facility [30H]
Authors: Moss Chailee , Isley Michelle 
Published: May 2017

INTRODUCTION:
Narcotic addiction has been linked to legal prescription of narcotics by physicians. Narcotic prescriptions for gynecologic surgical procedures vary widely and little data exist to quantify prescribing practices. The present study aimed to describe narcotic prescription practices in gynecologic surgeries.

METHODS:
We examined gynecologic cases in a retrospective chart review of 8 months from 2014 to 2015. Patient characteristics (age, weight, insurance status, prior narcotic prescription, race, ethnicity, resident team or private physician) and discharge prescription data were collected from 549 cases. Prescriptions were converted into equivalent oral morphine doses for comparison (e.g. 5 mg oxycodone equals 7.5 mg oral morphine).

RESULTS:
Prescriptions associated with open gynecologic procedures were significantly larger than all other procedure types (P < .001); inpatient laparoscopy prescriptions were larger than any outpatient procedures (P < .001). Mean total prescriptions for surgery categories (in milligrams of oral morphine) were: vulvar and cervical - 90; uterine (e.g. hysteroscopy, dilation and curettage) - 50; outpatient laparoscopy - 137; inpatient laparoscopy and vaginal surgery - 267; and open - 323. No significant differences were correlated to age, weight, race, insurance, or care team. Of note, 43% of patients had a narcotic prescription in the five years preceding surgery.

CONCLUSION:
Narcotic prescription practices are widely varied, and significantly different between procedure types. Many patients have prescription narcotic exposure prior to a gynecologic procedure. More study is needed to evaluate how much narcotic patients utilize for gynecologic procedures to avoid excessive prescribing.