bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Ob-Gyn and Women's Health Selective Pathway for Senior Medical Students [7O]
Authors: Castro Lony , Wong Shirley , Nausheen Fauzia , Al-Eyd Ghaith , Valenzuela Guillermo , Tenore Alfred 
Published: May 2017

INTRODUCTION:
The content of year 4 of medical school and student to resident transition are the subject of debate. The AAMC has outlined “Entrustable Professional Activities” (EPAs) expected of all physicians on day 1 of residency. An added concern of residency directors is that graduating students may not be adequately prepared for their chosen specialty. To meet these challenges, CalMed-SOM, an LCME applicant school with an active learning curriculum, has designed a 4th year selective pathway.

METHODS:
Faculty in Ob-Gyn, Anatomy, Pathology, and Medical Education established goals for the knowledge, skills, and attitudes desired of a beginning Ob-Gyn resident and the content and pedagogies required for the pathway based on: 1) specialty specific requirements; 2) broader learning outcomes (e.g. AAMC EPA's and CalMed-SOM core competencies); 3) our collective experience educating residents. Formative and summative assessments were designed to determine students' proficiency levels in the desired competencies.

RESULTS:
A 4th year Ob-Gyn and Women's Health Selective Pathway was created with 4 clinically integrated experiences: 1) the Clinical Pelvic Anatomy Laboratory (4 weeks), with a surgical skills component using fresh cadavers; 2) Ob-Gyn Surgical Pathology (4 weeks); 3) Diagnostic Imaging (4 weeks); 4) the Ob-Gyn Sub-Internship (8 weeks). Curriculum mapping demonstrated content integration across the 4 years of the curriculum.

CONCLUSION:
A 4th year pathway in Ob-Gyn and Women's Health can be designed to meet the aspiring Ob-Gyn's need for a curriculum that fulfills general and specialty specific competencies. Assessment results as well as program director and resident surveys will guide further modifications of this pathway.
Genetic Testing Requests on Gamete Donors After Conception; Pre-Test Counseling Considerations for Patients [8O]
Authors: Callum Pamela 
Published: May 2017

INTRODUCTION:
To document the requests for genetic testing on gamete donors after conception and outline counseling considerations for patients to be informed about prior to testing.

METHODS:
All requests for additional genetic testing on sperm donors from January 2013 through September 2016 were reviewed and sorted to identify requests received during ongoing pregnancies.

RESULTS:
Fifty-two requests for additional genetic testing on sperm donors were received. Most requests involved carrier screening for conditions for which patients were identified to be carriers. Some requests involved microarray findings in fetuses that required additional donor testing in order to help interpret fetal risks. Donors in our program are frequently available and willing to participate in additional testing but their availability is not guaranteed and testing can take several weeks or months. This can cause patient distress during pregnancy when the donor is unavailable or willing to have testing or if donor testing takes considerable time to accommodate.

CONCLUSION:
Requests for additional testing on gamete donors are frequently received to help define the risks to a fetus. Prior to testing, patients should be counseled about the potential limitations of testing on a donor should testing be warranted. This will aid in their decision-making process prior to performing testing and help to prepare them for the circumstances they could encounter following their own positive test results.
Is the New Terminology of “Triple I” For Chorioamnionitis Really Different? [10O]
Authors: Williams Nayo , Misra Neeti , Lin Yong 
Published: May 2017

INTRODUCTION:
The proposed terminology of “Triple I” was developed to clarify the heterogeneity of manifestations associated with chorioamnionitis. This study aims to evaluate if those with a concordant (both histological and clinical) diagnosis of chorioamnionitis are different from those that do not meet the confirmed “Triple I” criteria.

METHODS:
Retrospective three-year analysis of term patients with chorioamnionitis classified as: 1) clinical (CCA)–via ICD-9 codes, 2) histological (HCA), 3) concordant. Variables evaluated: age, gravidity, white blood cell (WBC) count, gestational age, Group B Strep, rupture of membranes, epidural, highest temperature, fetal heart tracing prior to cesarean, Apgar score, infant sex, special care nursery (SCN) admission and presence of bandemia in infant. Analysis by multinomial logistic regression.

RESULTS:
In the CCA, HCA and concordant group there were 27, 51 and 23 subjects, respectively. When compared to the concordant group, three variables had statistical significance (P < 0.05). In CCA and HCA, for every one-unit increase in WBC they are 18.6% (95% CI 0.65-0.95) and 17.3% (95% CI 0.69-0.99) less likely to match with concordant group, respectively. The HCA group is 96.6% (95% CI 0.003-0.387) less likely to be a primigravida and are 12.3 times (95% CI 2.8-53.6) more likely not to have infant in SCN.

CONCLUSION:
Our analysis finds the concordant group (confirmed Triple-I) is similar to CCA and HCA group. In term patients, the terminology “Triple I” does not bring clarity to the diagnosis of chorioamnionitis. Therefore, additional research is needed to refine the diagnosis criteria. This will improve maternal and neonatal management by providers.
Availability of Zika Virus Testing Information on Local Health Department Websites in the State of Texas [14O]
Authors: Adesomo Adebayo , Page-Ramsey Sarah M. , Ireland Kayla , Sullivan Adriana , Rodriguez Emma , Ramsey Patrick S. 
Published: May 2017

INTRODUCTION:
Zika virus infection is an emerging health threat. It is important that obstetric providers can easily access Zika virus testing information. Our objective was to evaluate the availability of information about Zika virus testing on county and regional health department websites in Texas.

METHODS:
We reviewed all Texas county, regional, and metropolitan health department websites for information on testing patients with suspected Zika virus infection. Information abstracted included education on appropriate patient selection for testing, where to have blood drawn, where to submit specimens, availability of testing forms, and contacts for additional testing information. In cases where information about Zika virus testing did not appear immediately on the main webpage, an internal search of the site using the terms “Zika” was performed.

RESULTS:
Information for providers about Zika virus testing was identified on 3.1% of 254 county health department websites, 9.1% of the 11 public health region websites, and 5.0% of the 39 metropolitan health department websites. Very few websites had access to testing guidelines and testing forms available for providers.

CONCLUSION:
Growing concerns about Zika virus warrant guidance for healthcare providers on testing. The Centers for Disease Control recommends patients contact healthcare providers for guidance on testing, and that providers seek guidance from local public health departments. Providers in Texas have poor access to local and regional information for testing through these online resources. Improved local efforts are needed to assist providers with guidance on Zika testing.
Interpregnancy Interval in Placenta Previa With Morbidly Adherent Placenta [15O]
Authors: Shamshirsaz Amir A. , Erfani Hadi , Salmanian Bahram , Fox Karin A. , Vidaeff Alex C. 
Published: May 2017

INTRODUCTION:
To evaluate whether there is a difference in interpregnancy interval between women diagnosed with placenta previa and morbidly adherent placenta (MAP) and those with placenta previa without MAP.

METHODS:
Retrospective case-control study of women with previous cesarean delivery and index pregnancy complicated by placenta previa. Cases had pathology proven MAP (n=39). Controls (n=39) without MAP were matched by number of previous cesarean deliveries. Primary outcome was the interpregnancy interval. A number of secondary maternal and neonatal outcome were also recorded. Data were reported as mean ± SD, median (IQR) and rates. Comparisons and adjustments were made using t-test, Mann Whitney U test, chi square test, ANCOVA and multinomial logistic regression.

RESULTS:
Median interpregnancy interval was 42 (20, 60) months in the placenta previa with MAP group and 43 (24, 86) months in the placenta previa without MAP group (P = NS). Gestational age at delivery and birth weight were lower in the MAP group (P < 0.001) with a significant increase in RDS rate. As expected, gravidity and parity were higher in the MAP group (P < 0.001). In the same group, the median estimated blood loss and use of blood products at delivery were higher and the hospital stay longer.

CONCLUSION:
In contrast to similar previous publications, we placed special emphasis on the use of comparable populations as cases and controls. Another strength of our study is case ascertainment, limiting the cases to women who underwent hysterectomy. Our data do not suggest an association between interpregnancy interval and MAP in women with placenta previa.
A Systematic Review and Statistical Analysis of Prenatal Non-Invasive Diagnosis of Sickle Cell Disease [27O]
Authors: Beebeejaun Yusuf , Short Lauren , Oteng-Ntim Eugene 
Published: May 2017

INTRODUCTION:
With over 2 million American affected by Sickle Cell Disease (SCD) and an estimated 17,000 women affected by the disease in the United Kingdom, pregnancies complicated by SCD can be very challenging with various maternal and fetal complications. Currently, for SCD to be tested prenatally, fetal DNA is extracted by amniocentesis, chorionic villus sampling or cordocentesis and then analyzed by polymerase chain reaction (PCR). However, these procedures increase the risk of fetal miscarriage by up to 1%. In this presentation, we explore the efficacy of testing for SCD, non-invasively, using cell-free fetal DNA (cffDNA), which is extracted from maternal blood plasma.

METHODS:
Using literature databases we systematically reviewed existing studies pertaining to the use of cffDNA for non-invasive prenatal testing or diagnosis for SCD. The data collected as statistically analyzed, with the aim of appraising the sensitivity and specificity of this method of prenatal testing.

RESULTS:
Our analysis an average of 87.20% accuracy of diagnosis when using cffDNA to test for SCD, with 7.51% of fetuses incorrectly diagnosed.

CONCLUSION:
SCD is associated with significant maternal fetal complications such as intra uterine growth restrictions and preeclampsia. CffDNA for non-invasive prenatal SCD diagnosis appears to have the potential to be an accurate technique for the testing of this genetic disease. Whilst there are currently very limited data on the use of this technique for the specific testing of SCD, there is great opportunity for further research into the standardization and clinical application of this procedure.
Timing and Indications for Delivery at Less Than 39 Weeks in Neonates With Complex Congenital Heart Disease [28O]
Authors: Belay Wubishet , Davis-Nelson Shareece , Gates Judy , Hopper Andrew , Goff Donna 
Published: May 2017

INTRODUCTION:
To describe timing and indications for delivery at less than 39 weeks of gestation in neonates with complex congenital heart disease (CCHD).

METHODS:
All neonates with CCHD admitted to Loma Linda University Children's Hospital from 2011 to 2015 were included in this study. Review of medical records was performed to collect data regarding CCHD lesion, maternal medical or fetal conditions and indication for delivery at less than 39 weeks of gestation. Indications for delivery were summarized by categories based on gestational age. Descriptive statistics were used to compare the groups.

RESULTS:
There were a total of 330 neonates admitted with CCHD during the study period with 129/330 (39%) born at less than 39 weeks GA with spontaneous labor in 54/129 (42%). The majority, 81/129 (63%) were born at early term, 34/129 (26%) were late preterm births and 14/129 (11%) were born prior to 34 weeks of gestation. Pregestational and gestational diabetes complicated 34/129 (26%) of the pregnancies while hypertensive disorders of pregnancy and intrauterine growth retardation were present in 18/129 (14%) and 13/129 (10%) of pregnancies, respectively. Vaginal and cesarean section deliveries accounted for 53% and 47% of the cases, respectively. Repeat cesarean sections with and without labor (38%), non-reassuring fetal heart rate patterns (21%) and breech presentation (20%) were the main indications for cesarean delivery.

CONCLUSION:
Delivery at less than 39 weeks of gestation is common in neonates with CCHD and more likely reflective of preterm labor, maternal medical or fetal condition rather than elective delivery.
Tocometry Rule-In After Maternal Accident (TRAuMA): Does It Affect Neonatal Outcomes? [30O]
Authors: Rojas Kristin E. , Kreczko Alicja , Raker Christina , Matteson Kristen , Vrees Roxanne 
Published: May 2017

INTRODUCTION:
Minor trauma patients with viable pregnancies with at least 6 contractions per hour in 4 hours “rule-in” for 24 hours of monitoring to detect early abruption. We sought to determine if women who “rule-in” are at greater risk for adverse neonatal outcomes than those who “rule out” for extended monitoring.

METHODS:
A retrospective chart review included women with viable pregnancies in the Emergency Department following minor trauma between 2008 and 2013. Minor trauma included low-speed motor vehicle accident, falls, and assault. The primary outcome was NICU admission or fetal demise.

RESULTS:
Six-hundred and three minor trauma patients with viable pregnancies were included. Age, substance abuse, race, pregnancy comorbidities, and mode of delivery were not significantly different between groups. Women who “ruled-in” had significantly greater gestational age at presentation (34.2 weeks vs. 30.2 weeks p < 0.0001), less days from trauma to delivery (34.8 vs. 63.4 p < 0.0001), more motor vehicle accidents (32.4% vs. 22.8% p=0.03), and were more likely to report contractions (34.2% vs. 14.6% p < 0.0001). The rate of abruption was not significantly different between groups (ruled-in: 2.3% vs. ruled-out: 1.4%, p=0.5). Ten percent of those who “ruled-in” and 11% of those who “ruled-out” experienced the primary outcome, but this was not significantly different (RR=0.86 95% CI 0.55-1.35).

CONCLUSION:
Patients who “ruled-in” for extended monitoring were not found to have a greater risk of fetal demise or NICU admission than those who “ruled-out”. The current risk assessment and management algorithm of obstetric minor trauma patients should be re-examined.
Emergency Cesarean Section – Benefit or Extra Maternal Harm? [34O]
Authors: Tuck Alexis X. , Kesavan Meera , Blood Danielle , Morgan Dorcas 
Published: May 2017

INTRODUCTION:
To determine the outcomes including complications that occur when an emergency code, “Condition Pink” is used on labor and delivery for either maternal or fetal reasons.

METHODS:
Retrospective chart review was conducted on all patients who delivered at New York University – Lutheran Medical Center between January 2014 and December 2015. Fifty – eight patients had a “Condition Pink” called. Mode of delivery, neonatal Apgar scores and maternal complications such as infection, hemorrhage, and bladder injury were reported. Also reviewed were readmissions to the hospital. Because majority of these women had cesarean deliveries, they were compared to women who underwent cesarean deliveries during that same time period. Statistical significance was assessed using the chi-squared test.

RESULTS:
All 56 emergent cesarean deliveries and a random sample of 96 non-emergent cesarean deliveries were selected. Patients requiring an emergent cesarean delivery were found to have a 16% (9/56) chance of overall maternal complications while non-emergent cesarean deliveries had only a 5% (5/96) chance (P=0.039). Risk of individual maternal complications, including postpartum hemorrhage, bowel or bladder injury, and postoperative infection were also evaluated, but these individual outcomes were relatively rare and differences between groups were not statistically significant.

CONCLUSION:
Emergent Cesarean sections (where a maternal or fetal emergency warrants immediate delivery of the fetus) carry an increased risk of overall maternal complications.
Efficacy of Suture Material in Prophylactic and Rescue Transvaginal Cervical Cerclages: A Retrospective Analysis [35O]
Authors: Daigle Patrick , Savage Megan , Bergeron Michelle , Karlin Samantha , Hagan Joseph , Stafford Irene 
Published: May 2017

INTRODUCTION:
Cervical cerclage has been used for cervical insufficiency to reduce the risks of premature birth. There is limited data on the efficacy of commonly used cerclage materials. This study was conducted to compare the efficacy of monofilament, braided, and 5mm tape suture in prophylactic and rescue cerclages.

METHODS:
A chart review of women who received a prophylactic or rescue cerclage between January 2011- December 2015 at Touro Infirmary, New Orleans was performed. The Wilcoxon rank sum test was used to compare gestational age at delivery achieved with different sutures. Fisher's exact test was used to compare gestational age at delivery (≥32, 34, and 37 weeks) between different sutures. SAS version 9.4 was used for data analysis. A 5% significance level was used for hypothesis tests.

RESULTS:
Thirty four pregnant patients received a cerclage. Sixteen received braided sutures, 12 received monofilament sutures, and 6 received 5 mm tape. The gestational age at delivery was higher for those who received monofilament sutures compared to braided (p= 0.010). The gestational age at delivery for patients who received tape fell between monofilament and braided, but was not significantly different from either (p= 0.367 and 0.782 respectively). A higher proportion of patients who received monofilament sutures delivered at greater than 32 (p= 0.016), 34 (p= 0.024), and 37 (p= 0.017) weeks compared to patients who received braided sutures.

CONCLUSION:
Our study confirmed that monofilament sutures are superior to braided sutures in achieving greater gestational age at time of delivery, demonstrating that suture material does have an effect on cerclage efficacy.
Value of Mandatory Statewide Collection of Demographic Data About Obstetrician-Gynecologists [4E]
Authors: Moffett Maurice , Rayburn William F. , Pearson Amy Farnbach , Larson Richard 
Published: May 2017

INTRODUCTION:
The New Mexico Workforce Data Collection, Analysis, and Policy Act of 2011 requires that all providers respond to a mandatory survey when obtaining or renewing (every 3 years) a medical license. This study highlights the value of continuously collecting a breadth of data about the entire obstetrician-gynecologist (ob-gyn) workforce for health policy initiatives.

METHODS:
All medical doctors licensed in New Mexico in 2015 with board certification in ob-gyn or gynecology only were included. License renewal survey data were collected between 2010 to 2015.

RESULTS:
In 2015, there were 316 licensed ob-gyn physicians in New Mexico, yet 213 (67.4%) practiced at a New Mexico address (54.9% female, 45.1% male). The proportion who practiced ob-gyn (83.0%) versus gynecology only (17.0%) remained constant. By age, 71.6% of the males and 33.9% of females were 55 or older. Nearly one-fourth (22.8%) worked part-time, regardless of gender. The 28.8% of all ob-gyns who practiced in rural counties (18.4% of females; 41.5% of males) saw more outpatients. Only 23.5% were owner/operators of independent practices, while 31.9% were employed as organizationally-affiliated providers. Net migration was positive between 2010 and 2015 (n = 70) with most practicing in metropolitan counties after migrating from another state.

CONCLUSION:
As demonstrated in New Mexico, mandatory collection of physician demographic and practice data at the time of licensure or relicensure provides a rich source of information to evaluate snapshots and trends of the ob-gyn workforce at a state level.
Residency Satisfaction in Ambulatory Clinics: Improvement Is Possible [9E]
Authors: Kole Martha , Friedman M. Alexandra , Eger Renee 
Published: May 2017

INTRODUCTION:
Low provider satisfaction has been documented in trainee ambulatory clinics across specialties despite the importance of ambulatory care and patient management in residency training. An OB-GYN resident ambulatory clinic based in a large academic center led an initiative to improve clinic flow and overall provider satisfaction through the addition of scheduling changes, improved clinic logistics, dedicated didactic time for clinic coordination, and increased continuity through resident and nurse practitioner teams.

METHODS:
A 360 degree survey was created and piloted as part of the quality improvement process. Surveys were distributed to resident physicians for a baseline measure, and one year following clinic changes. Surveys were ten minutes in length, and were completed during resident didactic time.

RESULTS:
Of the 32 residents invited to participate 26 completed the pre-survey (81%) and 25 completed the post-survey (78%). Of residents surveyed, 23% of those who completed the pre-test, and 24% of those who completed the post-test were interns. Following improvement initiatives in the clinic, residents reported increased overall satisfaction (PRE, POST p=0.014). Most specifically residents noted increased satisfaction with the waiting room experience (PRE, POST p < 0.001), visit experience (PRE, POST p=0.02), continuity (PRE, POST p=0.05), and checkout process (PRE, POST p=0.02). Additionally, residents were more likely to refer a friend to the ambulatory clinic following these changes (p=0.014).

CONCLUSION:
Residents historically report low satisfaction in the ambulatory clinics setting. With increased time and resources dedicated to improving infrastructure, education and continuity, residents can have a more positive outpatient experience.
Group Prenatal Care and Its Effects on Triage Visits [12E]
Authors: Gullatt Erin , White Anna 
Published: May 2017

INTRODUCTION:
Group prenatal care has a positive impact on patients and their pregnancy. We investigated effects of group prenatal care on number of patient initiated triage visits, gestational age at delivery, breastfeeding initiation rates, and attendance at postpartum visit.

METHODS:
Pregnant women receiving traditional prenatal care at a private obstetric clinic, traditional prenatal care at a resident clinic, and group prenatal care were compared through single-site, retrospective chart review. Multiple gestations, prenatal care beginning after 20 weeks gestation, and patients without documented delivery were excluded. The number of triage visits, gestational age at delivery, breastfeeding initiation, and postpartum visit attendance was collected through chart review. We used Zero-inflated Poisson regression to analyze triage visits and Chi-square analysis to analyze gestational age at delivery, feeding methods, and postpartum appointment attendance.

RESULTS:
Group prenatal care patients had increased patient initiated triage visits (p=0.0187). There was no difference between private patients compared to group prenatal care patients or when comparing private patients to resident patients. Group care patients had higher breastfeeding initiation (70%) than private (63%) and resident patients (57%), (P=0.3777). Postpartum visit attendance was higher in group care (95%) than in private (84%) and resident patients (81%) (P=0.1240). There were no differences in gestational age at delivery (P=0.122).

CONCLUSION:
Group prenatal care patients present more often to triage for evaluation than those receiving routine prenatal care, possibly due to increased education and symptom awareness in this patient group. Although not statistically significant, group prenatal care patients have slightly higher breastfeeding initiation rates, and postpartum appointment attendance.