bluuebunny/crossref_metadata_2025_split huggingface dataset:
Attitudes Regarding Transitions of Care of Obstetric and Gynecology Patients in a County Hospital Setting [20I]
Authors: Jackson Angalene , Marshall Hayley , Hoang Christine , Kremer Timothy 
Published: May 2017

INTRODUCTION:
Handoffs and transitions of care have been a central part of patient safety goals at John Peter Smith Hospital. With twice daily shift changes for physician and nurses, the Department of Obstetrics and Gynecology introduced a new interdisciplinary team transition of care system. Initial anecdotal feedback suggested that the handoff process was suboptimal and communication efforts could be improved. The purpose of the study was to evaluate attitudes of faculty, residents, and nursing staff about a transition of care system and identify opportunities to improve the safety and quality of care involving antepartum, postpartum, and gynecology patients.

METHODS:
An anonymous online survey was administered to physicians and nurses participating in the new handoff system. The results were analyzed to identify opportunities for improvement.

RESULTS:
Responses were analyzed from 21 members of the interdisciplinary team. 47% of the respondents found the transition of care system helpful. 55% felt their goals for handoffs were accomplished. All respondents reported importance in addressing updates on patient plans of care and anticipated discharge dates. Content of handoffs should focus on the acute and critically ill patients. The attending physician, chief resident, and nursing team leaders should participate in the handoff process.

CONCLUSION:
Differences in goals and content focus between physicians and nurses contributed to suboptimal communication and handoffs. Identifying the deficits allows opportunities for improvement in transitioning care and ultimately the safety and quality of care provided to patients. Participation in the process should include faculty physicians, chief residents, and nursing leaders.
Incorporation of “One Health” Into Obstetrics and Gynecology [21I]
Authors: Jasani Sona , Fuchs Ashley , Jasani Sona , Bergmann Jonathan , Spencer Brint , Bachmann Gloria 
Published: May 2017

INTRODUCTION:
It has been well established that there is high conservation between humans and animal organisms in their biology, genetics, and diseases. The “One Health” movement, which is an effort to have multiple health disciplines collaborate to improve the health of people, animals and the environment, is particularly suited to obstetrics and gynecology. Veterinarians are involved not only in the various obstetrical dystocias, pelvic floor prolapse and contraceptive issues of many mammals, including primates, but also in species conservation and breeding programs. An opportunity exists for OB/GYN programs to become more involved with zoos and wildlife parks in their locale.

METHODS:
The Rutgers OB/GYN department established a partnership with Turtle Back Zoo (a national AZA accredited site) such that physicians, fellows, residents and medical students interface with the professionals working there.

RESULTS:
This partnership has not only resulted in the exchange of education from a reproductive endocrinology, contraceptive, and obstetrical perspective, but also in providing needed equipment to the Zoo. It was noted that many of the items discarded after a surgical procedure (sutures, drapes, disposable instruments, etc) at our academic teaching hospital that cannot be used again for humans is suitable for veterinary use.

CONCLUSION:
Medical institutions and veterinary colleges have traditionally worked in isolated silos. There are few collaborations and comparative studies across the two disciplines. However, with diseases manifesting similarly in humans and animals, there is a wealth of information to be tapped into and we propose greater collaboration through the “One Health” initiative.
Obstetrics and Gynecology Fellowship Interview Preferences [22I]
Authors: Barnard Emily , Byrnes Jenifer , Occhino John A. 
Published: May 2017

INTRODUCTION:
The number of applicants to Obstetrics and Gynecology subspecialty fellowships is projected to increase; however, it is known that the interview process is taxing for both applicants and the programs they attend. Concerns include excessive time away from work, cost, lack of coordination for regional travel, and overlapping interview dates. Little is known about applicant preferences for interviewing.

METHODS:
An e-mail link to a survey designed using web-based tool SurveyMonkey was sent to all residency directors for distribution to fourth year residents at ACGME-accredited Obstetrics and Gynecology programs in the United States.

RESULTS:
A total of 190 residents responded, 138 of whom applied to fellowship in 2016. Applicants were predominantly female (73.6%), Caucasian (78.3%), married (76.7%), and without children (74.4%). Most (81.3%) were from an academic program. Applicants attended a mean of 10.9 interviews; the most common reason to cancel was conflict with another interview (72.3%). Saturday was the most preferred interview day (46.7%). The majority of applicants preferred half-day interviews (93.2%), and 61.0% preferred an 0800 start to earlier or later times. A pre-interview dinner was favored (64.4%) with work restraints being the largest barrier to attendance. Personal days granted for interviews varied by program from zero (16.1%) to greater than 11 (25.0%). Vacation and unpaid leave were utilized by 56.5% and 9.0% respectively.

CONCLUSION:
Interviewing for fellowship is a burdensome process, but it could be improved by implementing regional coordination, shorter interview days and weekend interview dates. Gathering information from applicants and fellowship directors can help further streamline the process.
Correlation Between Perceived Versus Actual Proficiency in OBGYN Residency Training for Obstetric Ultrasounds [23I]
Authors: Sulmers Christine , Diaz-Sylvester Paula , Groesch Kathleen , Patterson Jacquelyn , Delfino Kristin , Taylor Funminiyi 
Published: May 2017

INTRODUCTION:
Accreditation Council for Graduate Medical Education (ACGME) describes “the full range of commonly employed obstetrical diagnostic procedures, including ultrasonography” as one of the critical competencies required for graduation from an Obstetrics and Gynecology (Ob/Gyn) residency program. Although evidence suggests weaknesses in ultrasound curriculum, this is primarily based on perception and not proficiency. We explored the correlation between perceived knowledge, skill/performance and comfort teaching/supervising obstetric ultrasound and actual proficiency.

METHODS:
A needs assessment survey was disseminated to all ACGME-approved Ob/Gyn residency programs in the U.S.A. Questions evaluating proficiency were correlated with perceived knowledge, skill/performance and comfort teaching/supervising obstetric ultrasound.

RESULTS:
One-hundred-forty-four residents completed the survey. A positive correlation was noted between perceived knowledge and actual proficiency in: effect of frequency on image resolution, principle of as low as reasonably achievable (ALARA), fetal heart rate assessment, components of the anatomic survey; skill/performance in performing growth survey; comfort teaching/supervising growth ultrasound, identification of appropriate images for biparietal diameter and abdominal circumference assessments and recognizing gastroschisis. There was a negative correlation in perceived skill/performance in first trimester ultrasound and identifying the correct first trimester crown rump length image. Higher PGY-level respondents tended to answer the question of effect of resolution on image quality correctly, though they also tended to answer the question regarding first trimester crown rump length incorrectly.

CONCLUSION:
There appears to be a correlation between perceived knowledge, skill/performance and comfort teaching/supervising and actual proficiency. Results of this study may be utilized to integrate future interventions directed towards obstetric ultrasound education.
What Do Medical Students Interested in Obstetrics and Gynecology Value in Their Future Careers? [28I]
Authors: Nguyen My-Linh , Mei Jenny Y. , Mularz Amanda , Maykin Melanie 
Published: May 2017

INTRODUCTION:
To identify the personal values and desired practice patterns held by medical students who have high interest in obstetrics and gynecology.

METHODS:
We recruited 2nd-year medical students to complete an institutional survey on early career interests, which was developed to assess specialty interests and characterize factors that may affect career choice (adapted from the AAMC 2015 Matriculating Student Questionnaire). Level of interest in OB/GYN was rated from 1 (no interest) to 5 (high interest). Level of importance of personal values and practice preferences was rated from 1 (not important) to 4 (essential). Spearman’s rank correlation coefficient was used to correlate variables, P < 0.05 as significant.

RESULTS:
160 students completed surveys. 44% (71) were male and 56% (89) female. Median age was 25 (range: 22-33) years. Medical student interest in OB/GYN positively correlated with a desire to work for social change (0.365, p < .001), expression of personal values (0.189, p=0.017), desire to work with patients of lower socioeconomic status (-0.208, p=0.008), longer patient continuity (0.265, p=0.001) and preference for younger patients (0.173, p=0.029). Higher interest in OB/GYN correlated with older age of the student (0.222, p=0.005). OB/GYN interest negatively correlated with desire for high income potential (-0.197, p=0.013).

CONCLUSION:
Interest in OB/GYN correlates with socially minded values such as working for social change, expression of personal values and working with the underserved. They preferred longer continuity of care, and working with younger patients. Larger studies are underway to determine the relative importance of these factors in students who eventually enter OB/GYN careers.
Impacts of Volunteer-Run Clinics on the Next Generation of Health Care Professionals and Their Career Preferences [30I]
Authors: O'Rourke Katherine , Kruse Carly , Landry Mary , Durand Madeline , Graziano Scott 
Published: May 2017

INTRODUCTION:
Two medical schools partnered with community organizations to provide free gynecologic care to uninsured women. The clinics integrate community outreach, patient care, and a peer-teaching model. Both are volunteer-run with the mission to improve the health of underserved women in need of gynecologic care and enhance student education and career development.

METHODS:
Student volunteers completed an 18-item, open-ended survey evaluating motives for volunteering and the impact on education. Surveys were sent electronically to volunteers (n=137) with a response rate of 51%. Results were thematically coded and analyzed by two separate individuals.

RESULTS:
Students reported their motives for volunteering were to: gain experience in gynecology or women’s health (65%), learn about and contribute to underserved medicine (55%), and increase clinical experiences (36%). All students reported achieving their self-identified goals. Peer teaching provided a positive experience for 98%, with students valuing learning from upperclassmen and teaching underclassmen. Volunteering sparked, increased, or confirmed an interest in a career in obstetrics and gynecology (48%) and women’s health (11%). Volunteering also sparked, increased, or confirmed interest in a career in underserved medicine (79%) and academic medicine (41%).

CONCLUSION:
Volunteer-run clinics provide opportunities for the growth of our next generation of physicians. Through this model, medical students participate in a unique space to set and achieve career goals while simultaneously improving upon clinical skills. At Share the Health, career goals that developed or were reinforced included gynecology, women’s health, and underserved medicine. Further studies might explore if current OB/Gyn physicians had similar experiences to inform career choices.
Description of Medium- and Long-Term Complications After PCN Placement for Malignant Urinary Obstruction [1J]
Authors: Acosta-Torres Stefany , McDevitt Joseph , Zhang Ning , Xi Yin , Pillai Anil , Miller David S. 
Published: May 2017

INTRODUCTION:
There is little data on medium- and long-term complications after placement of percutaneous nephrostomy tubes (PCNs) placed for malignant urinary obstruction due to gynecologic cancers and no evidence-based recommendations to guide time to PCN exchange. We sought to define the frequency and time distribution of these complications.

METHODS:
Patients with malignant urinary obstruction due to a gynecologic malignancy that underwent placement and at least one exchange of a PCN between 2011 and 2013 were reviewed. Exchanges were classified as routine (not due to a complication), or due to one of three complication types: mechanical (tube dislodgement), obstruction, or infection (i.e. pyelonephritis).

RESULTS:
Thirty-three patients with 59 exchange encounters were included. Twenty-six (79%) patients had cervical cancer. Twenty-one (36%) of exchange encounters were routine, occurring at a median of 96 days (interquartile range: 91-101 days), while 15 (25%) were due to tube obstruction, occurring at a median of 48 days (IQR: 15-59 days). Seventeen (29%) were due to infection, occurring at a median of 66 days (IQR: 38-93 days), and 6 (10%) were due to mechanical dislodgement, occurring at a median of 66 days (IQR: 52-82 days).

CONCLUSION:
Medium- and long-term complications were frequent after PCN placement for obstruction due to gynecologic malignancies, as nearly two-thirds of exchanges were due to a complication. Additionally, the median time for each complication type is nearly one month before the currently recommended scheduled routine exchange time. Further work can quantify the excess cost due to these complications and determine the most cost-effective time for routine scheduled exchanges.
Antegrade (AG) Versus Retrograde (RG) Stents for Ureteral Obstruction (UO) In Locally Advanced Cervical Cancer (CC) [3J]
Authors: Talati Asha , Sheyn David , Zakem Sarah , Zanotti Kristine 
Published: May 2017

INTRODUCTION:
UO is common in patients with newly diagnosed CC. Management of UO commonly occurs with stent or nephrostomy placement (NT). The success rates for AG and RG stents amongst this group have not been reported. We sought to document performance of these procedures to inform comparative effectiveness studies.

METHODS:
Medical records of patients with locally advanced CC and UO treated at our institution between 2000 - 2009 were reviewed. Failure of a procedure was defined as worsening hydronephrosis on imaging, rising creatinine, or need for an alternate method of management.

RESULTS:
55 patients with stage IIIA-IVA CC were identified. Stages at presentation were 13% (IIIA), 60% (IIIB), and 27% (IVA). Fifty-one percent of patients presented with UO and 93% of these underwent a procedure. Fifty-four percent had attempted AG stent placement while 46% had attempt at RG stent. Thirty-eight percent of patients failed initial stent attempt: 50% failed via AG approach and 20% via RG. Amongst successful placement, mean number of follow up procedures secondary to stent failure was 3. Median stent survival was 120 days. Thirty percent of patients required long term management of UO with NT placement. Failure of UO management following NT placement was 0%.

CONCLUSION:
High short and long-term failure rates were seen with both AG and RG approaches and required multiple follow up procedures to manage UO. NT was most successful for long term management of UO. Given this, NT may be a reasonable initial management strategy for advanced stage CC with UO.
Association of Obesity With Transtheoretical Stage of Change and Self-Efficacy in Women With Endometrial Cancer [5J]
Authors: Chiu Kimberley , Nevadunsky Nicole , Van Arsdale Anne 
Published: May 2017

INTRODUCTION:
Exercise and lifestyle interventions may improve health metrics and quality of life in survivors of endometrial cancer. The purpose of this study was to evaluate the association between patient characteristics and self-efficacy as well as transtheoretical stage of change for diet or exercise in an ethnic/racially diverse population of women with endometrial cancer.

METHODS:
After IRB approval, 100 survivors of endometrial cancer completed a questionnaire including demographics, disease factors and co-morbidities. Transtheoretical Stage of Change and Self-Efficacy for Diet and Exercise were assessed using the Stages of Change Measure and Five Item Self Efficacy Measure. Associations were evaluated using Krusal Wallis and ANOVA testing, performed with Stata version 13.0.

RESULTS:
Mean age of 99 responders was 69 years and BMI was 34.1 kg/m2. There was a difference in BMI between stages of transtheoretical stage of change for exercise, maintenance vs contemplation (29.2 vs 38.0, p less than 0.01) and between stage of change for diet (38.6 vs 31.4, p=0.04) . Obesity (BMI greater than 30) was associated with the action stage of change when evaluated as a categorical variable (p less than 0.01). Self-efficacy for exercise as compared to transtheoretical stage of change was of borderline significance (p=0.08), however it was not significant for diet.

CONCLUSION:
In survivors of endometrial cancer, BMI was the only clinical/pathological factor associated with transtheoretical stage of change for exercise. Patient centered diet and exercise lifestyle intervention programs may consider patient BMI, and education as well as transtheoretical stage of change and self-efficacy to improve recruitment and retention.
Adequacy of Surgical Staging for Stage I Ovarian Carcinoma in a Military Tertiary Care Facility [7J]
Authors: Sawtelle Ashley L. , Miller Caela R. , Leath Charles A. , Dengler Katherine 
Published: May 2017

INTRODUCTION:
Ovarian cancer has a lifetime risk of 1 in 70 with 14,000 deaths in the United States in 2015. Surgical staging is the mainstay of ovarian cancer treatment with five-year survival for stage I ovarian cancer at 92.1% if completely staged. Our goal was to evaluate the adequacy of surgical staging in our low volume military treatment facility (MTF) to determine the need to centralize oncologic care.

METHODS:
We performed a retrospective chart review of all patients with stage I ovarian and fallopian tube cancer who received surgery at our MTF. Surgery had to include pelvic washings, lymph node sampling, peritoneal biopsy and omentectomy to be considered adequately staged. Complications, patient demographics and recurrence rates were also analyzed using chi-square analysis.

RESULTS:
Sixty two percent of patients were adequately staged. Of those that were inadequately staged, the majority had a clear reason; 31.2% were due to body habitus, 25% had borderline tumors and 12.5% had severe pelvic adhesive disease. Adequate staging increased surgery time by 50 minutes (P = .028), and had a statistically insignificant increased risk of complications. Interestingly, recurrence was more likely in those that were adequately staged (P = .02) and no patients that were inadequately staged had recurrence. Five year survival was 98%.

CONCLUSION:
Our five year survival rates are similar to other large referral centers nationwide. We postulate that our resource availability compensates for our low patient volumes, though more analysis is needed to determine exact causation.
Ovarian Cancer Risk Associated With Benign Gynecologic Conditions in African American Women [13J]
Authors: Park Hyo K. , Schildkraut Joellen M. , Cote Michele L. 
Published: May 2017

INTRODUCTION:
The association between common benign gynecologic conditions and ovarian cancer remains under-studied in African Americans (AA). Therefore, we examined the association between self-reported history of benign gynecologic conditions and epithelial ovarian cancer risk in AA women.

METHODS:
Data from a large population-based, multi-center case-control study of epithelial ovarian cancer in AA women were analyzed to estimate the association between self-reported history of endometriosis, fibroid, pelvic inflammatory disease (PID), and ovarian cyst with epithelial ovarian cancer. Logistic regression models were used to calculate odds ratios (OR) and 95% confidence intervals (CI) for the associations between individual and composite gynecologic conditions and ovarian cancer.

RESULTS:
628 cases and 752 controls enrolled in the African American Cancer Epidemiology Study between December 1, 2010 and December 31, 2015 were included in the analysis. After adjusting for potential confounders, a history of endometriosis was associated with ovarian cancer (OR 1.73; 95% CI 1.06-2.81). A modest association was observed with PID (OR 1.57; 95% CI 0.98-2.51), while no association was observed in women with a history of fibroid or ovarian cyst. A positive trend was observed for an increasing number of reported gynecologic conditions (p=0.002) with consistency across histologic subtypes and among both oral contraceptive users and non-users.

CONCLUSION:
A self-reported history of endometriosis among AA women was associated with increased risk of ovarian cancer. Having multiple benign gynecologic conditions had a cumulative effect on ovarian cancer risk.
Surgical Staging of Borderline Ovarian Tumors With and Without Lymphadenectomies: A Multi-Institutional Study [14J]
Authors: Padhy Radha R. 
Published: May 2017

INTRODUCTION:
In 2013, NCCN guidelines added the recommendation of lymphadenectomy on a case-by-case basis during comprehensive surgical staging of borderline ovarian tumors. In 2016, NCCN deleted comprehensive surgical staging for borderline tumors altogether. The objective of this study was to examine the recurrence rate between completely surgically staged borderline ovarian tumors with and without lymphadenectomies, and compare them to patients who were incompletely staged.

METHODS:
From 1998 to 2015, 128 borderline ovarian cancers were identified with concurrent frozen analysis and final pathologies. Fifty-nine cases (46%) underwent complete surgical staging: bilateral or unilateral salpingo-oophorectomy, omentectomy, resection of macroscopic implants, peritoneal biopsies/washings, and lymphadenectomy. Thirty-nine cases (30%) underwent complete surgical staging with all of the above performed except lymphadenectomy. The remaining 30 cases (23%) were incompletely staged. Recurrence was recorded following repeat surgical staging.

RESULTS:
Of the 59 cases that underwent complete surgical staging with lymphadenectomies (p < 0.001), 8 cases were upstaged due to positive lymph nodes. There were 5 recurrences (8.5%) in this group with only one involving positive lymph nodes. Of the 39 cases that underwent complete staging without lymphadenectomy, there was one recurrence (2.6%). The recurrence rate in the group of incompletely staged patients was higher (13.3%) with 4 recurrences.

CONCLUSION:
There was no statistically significant difference in recurrence rates whether lymphadenectomy was performed or not during the complete surgical staging procedure for borderline ovarian cancers. With lymphadenectomy now being discretionary within acceptable staging guidelines for borderline ovarian cancers, gynecologic generalists can consider complete surgical staging for such tumors when diagnosed on frozen analysis.