bluuebunny/crossref_metadata_2025_split huggingface dataset:
Risk Factors for Postpartum Depression Among Women at High Risk for Pelvic Floor Symptoms [9G]
Authors: DePorre Julia , Haefner Jessica , Berger Mitchell , Fenner Dee , Swenson Carolyn 
Published: May 2017

INTRODUCTION:
We sought to identify risk factors associated with a positive postpartum depression screen among women at high risk for pelvic floor symptoms and referred to a specialty postpartum clinic.

METHODS:
We performed a retrospective chart review of women seen between March 2012 and May 2016 at the Michigan Healthy Healing After Delivery Clinic at the University of Michigan, where patients are referred for early follow-up of obstetric anal sphincter injuries or pelvic floor symptoms related to childbirth. All new patients are screened for postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS). Women with an EPDS score greater than or equal to 10 (positive screen) were compared to those with a score under 10 (negative screen). Logistic regression was used to identify factors independently associated with a positive EPDS screen.

RESULTS:
Among 294 women, 46 (15.6%) had a positive EPDS screen. Women with a positive versus negative EPDS screen were more commonly referred for pain (30.4% vs 14.1%, P=.006), and had higher prevalences of urinary incontinence (35.6% vs 20.5%, P=0.027) and history of depression/anxiety (37.0% vs 17.7%, P=0.003). In multivariable logistic regression modeling controlling for age and race, factors that remained independently associated with a positive EPDS screen were non-white race (aOR 0.35, P=.006), referral for pain (aOR 3.03, P=.005), urinary incontinence (aOR 2.20, P=.04), and history of depression/anxiety (aOR 3.33, P=.003).

CONCLUSION:
Among women at high risk for postpartum pelvic floor symptoms, persistent pain and urinary incontinence may be risk factors of postpartum depression.
Moms in Medicine: A Descriptive Study of Job Satisfaction Among Physician-Mothers in Obstetrics & Gynecology [12G]
Authors: Heuser Cara C. , Gibbins Karen J. , Herrera Christina A. , Theilen Lauren H. , Holmgren Calla M. 
Published: May 2017

INTRODUCTION:
Physician satisfaction improves patient outcomes. The number of physicians who are also mothers is increasing. Our study aims to describe experiences of ob/gyn physicians who are also mothers.

METHODS:
Constructed and validated a Redcap survey. Invited members of an online ob/gyn-mom group to participate.

RESULTS:
We obtained 232 responses. Over 50% are hospital-employed, 20% in academics, and 20% in private practice. 70% work with trainees and half do research. Median clinical hours per week is 45, non-clinical 5. Over 75% perform deliveries and 60% have at least some in-house call. Most commonly used child-care are daycare/pre-school, K-12 school, and nanny/au-pair. Eighty-percent rate professional morale as very or somewhat positive and 80% would choose medicine as a career again although half would retire today if possible. Patient relationships and intellectual stimulation were the most important factors contributing to satisfaction; long-hours and liability/defensive medicine were the most common negative factors. Sixty-percent were unsatisfied with amount of time available to spend with children, 70% about time with partner, and 75% about time spent in personal hobbies/activities. 90% agree that motherhood has improved them as physicians; half agree that being a physician has made them better mothers. 80% agree that female physicians face unequal treatment; 75% agree that physician-parents face unequal treatment.

CONCLUSION:
Ob/gyn physician-mothers have high professional morale but are dissatisfied with amount of time available for extra-professional activities, especially family-time. Almost all respondents feel that motherhood had made them better physicians but only half feel that being a physician has made them better mothers.
Social Media Practices and Patient Interactions Among Healthcare Professionals [13G]
Authors: Davis Jay , Tompkins Emily , Chen Lian , Lai Monica , Hagan Joseph , Stafford Irene 
Published: May 2017

INTRODUCTION:
Social media (SM) has become widespread among healthcare professionals (HCPs) including attending-physicians, residents and medical students. It is unknown if engagement in social activity with patients on SM differs according to level of training. This study was conducted to survey HCPs on their SM practices as it pertains to personal disclosure and patient interactions.

METHODS:
A survey was conducted among HCPs pertaining to SM usage and patient-friendship requests. The chi-square test was used to compare different occupations’ frequency of and response to patient-friendship requests and disclosure of personal information on SM. SAS version 9.4 was used for analysis. A 5% significance level was used for hypothesis tests.

RESULTS:
Six hundred forty-six participants responded: 524 (81%) medical students, 91 (14%) residents, 25 (4%) attending-physicians, and 6 (1%) unknown. The proportion of respondents who display a personal photograph (59% of attending-physicians vs. 93% for other HCPs, p < 0.001) or their name on their SM profile (55% of attending-physicians vs. 84% for other HCPs, p < 0.001) differed by occupation with attending-physicians least likely to do so. The proportion of respondents reporting that they have received a patient-friendship request differed significantly with attending-physicians most likely to have received a request (36% vs 4% for other HCPs, p < 0.001) and students most likely to decide on an individual basis or accept (41% of students vs. 22% for other HCPs, p < 0.001).

CONCLUSION:
Although attending-physicians were more likely to receive a patient-friendship request, they were less likely to accept and disclose personal information on SM demonstrating concern for safety.
Sex Differences in Patient Satisfaction With Outpatient Obstetrics/Gynecology Care [14G]
Authors: Haunschild Carolyn , Altamirano Jonathan , Fassiotto Magali , Rogo-Gupta Lisa 
Published: May 2017

INTRODUCTION:
Sex differences in medicine are discussed in medical and lay literature. Female physicians receive lower compensation and are less likely to be promoted compared to males. Reimbursement may now include results of patient questionnaires which is concerning given the paucity of literature demonstrating validity in quality of care assessment. Obstetrics/Gynecology is especially subject to the impact of sex differences as discussing reproductive organs is inherently intimate. We hypothesize sex differences exist in patient evaluation of outpatient Obstetrics/Gynecology care measured by patient satisfaction surveys.

METHODS:
We analyzed 909 Press-Ganey patient satisfaction surveys linked to outpatient Obstetrics/Gynecology visits at Stanford Hospitals and Clinics (March 2013-June 2014). Likelihood to Recommend Physician (LTR) was rated on a 5-point scale and, due to its frequency distribution, was evaluated as receiving a 5 compared to 1-4 rating. Patient-physician demographic concordance was evaluated using chi-square tests. Office, Access, and Physician Assessments were generated from correlated PG questions and confirmed using factor analysis. Models to understand LTR controlling for patient, physician, and care environment characteristics were analyzed using generalized estimating equations (GEE), clustered by physician.

RESULTS:
Age and race concordance increased LTR (p=.01 and p < .0001, respectively) while sex concordance decreased LTR (p=.03). After controlling for patient, physician, and care environment characteristics, female physicians show a 49% decrease in odds of receiving a top LTR score (p=.003).

CONCLUSION:
Analysis of 909 patient satisfaction surveys demonstrates male Obstetricians/Gynecologists are rated higher than females in multivariate analysis, supporting our hypothesis that sex differences exist in patient evaluation and contrary to patient self-reported data.
Post-Approval Clinical Studies of Essure: Quality of Evidence and Future Outlook [16G]
Authors: Ukoha Erinma P. , Drury Kerry , Ghobadi Comeron , Xu Shuai , Walter Jessica 
Published: May 2017

INTRODUCTION:
Approved in 2002, Essure offers a method to achieve permanent sterilization via an office-based procedure. In late 2015, the FDA to re-investigated the device due to a rise in patient complaints ultimately leading to a new black box warning and the requirement of a new post-marketing study. Understanding the post-marketing clinical data surrounding the device’s safety and efficacy would inform clinicians in their patient counseling.

METHODS:
MEDLINE was queried using the search terms: Essure; hysteroscopic sterilization; postmarket approval; efficacy. The FDA and the manufacturers’ executive summaries on Essure, published in 2015, were mined as well. The quality of each study was rated using the Oxford Centre for Evidence-based Medicine Levels of Evidence scheme. A Grade 1 rating indicates a well-designed systematic review or randomized controlled trial while a Grade 5 rating indicates the weakest evidence quality (e.g. expert opinion).

RESULTS:
The search produced 231 unique references, of which 61 were considered relevant based on title and abstract. In aggregate, a total of 110,546 women were involved. The number of participants in each study ranged from 18 to 71,875. Overall, the majority of studies (74%) were rated Grade 4 (e.g. retrospective cohort, case-series, or case-controlled studies). Only 13% of studies were rated Grade 1 or Grade 2.

CONCLUSION:
The available post-marketing data is not of ideal quality, but the available evidence suggests that Essure is a safe and effective device for permanent female sterilization. The controversy will likely continue until completion of the new post-marketing study (n=2,800) comparing Essure with laparoscopic tubal sterilization.
Outcomes Associated With a Trial of Labor After Cesarean Section [22G]
Authors: Westbrook Brett , Felini Martha , Flood-Shaffer Kelly , Baker Austin , Papa Tracy , Anderson Ralph 
Published: May 2017

INTRODUCTION:
To examine the intrapartum outcomes of women attempting a trial of labor after cesarean section (TOLAC).

METHODS:
A retrospective chart review was performed on all patients who attempted a TOLAC from June 2012 to May 2016 at our county hospital. Primary outcomes assessed were successful vaginal delivery, labor onset, and prevalence of adverse maternal and infant outcomes.

RESULTS:
We identified 660 patients who attempted a TOLAC (2% of total births during the study period). The vaginal birth after Cesarean (VBAC) success rate was 67%, with significant differences by prior vaginal delivery, gestational age, and race/ethnicity. Successful VBAC was significantly more likely when the patient presented in spontaneous labor versus labor induction (74% vs 49%, P < 0.01). Conversely, more neonatal intensive care admissions occurred with labor induction (P=0.01), a difference not observed across delivery type (P=0.15). Maternal complications were more common in patients who required a cesarean delivery. There were 12 (1.8%) uterine ruptures. When compared to a previous TOLAC study conducted at the same hospital from 2004 through 2008, the VBAC success rate had decreased (67% vs 84%) and the rate of labor induction had increased (27% vs 4%).

CONCLUSION:
The overall VBAC success rate of 67% is within the expected range based on published data. However, our findings suggest the decrease in success across two time periods may be associated with an increase in induction of labor. To ensure patient safety and quality outcomes, targeted strategies are needed to assess the appropriate utilization of induction.
A Look Through Time: Analysis of William’s Obstetrics and Te Linde’s Operative Gynecology [26G]
Authors: Roeckner Jared , Peebles Amy B. 
Published: May 2017

INTRODUCTION:
In Obstetrics and Gynecology, few tomes are as well-respected as William’s Obstetrics and Te Linde’s Operative Gynecology. Tracing the changes in these texts provides a window to enlighten us on the history of our specialty. Our objective is to systematically analyze the Preface and Foreword of each edition of William’s and Te Linde’s to gain insight into historical changes in our field.

METHODS:
The Preface and Foreword from 24 editions of William’s Obstetrics and 11 editions of Te Linde’s Operative Gynecology were obtained. Documents were assessed for the inclusion of predefined keywords/topics including: gender-specific pronoun usage, insurance, sterilization/contraception, government regulation/laws, documentation burden, malpractice, race, medicine as art/science, and others. Data were extracted and analyzed using Excel.

RESULTS:
Changing pronoun usage was evident across both texts. From 1941-1950, physicians were referred to as male 19 times and only once as female. The ratio of male-to-female pronoun usage became 1:1 in the 1990s. From the 1970s onward, “Physician Woes” including malpractice, documentation burden, regulation and insurance were mentioned at increasing rates. Governmental regulation and evidence-based medicine were first mentioned in the 2000’s. Medicine was increasingly referred to as a “science” rather than an “art” within the last two decades. Race was not mentioned. “Change” and “Improvement” were noted almost universally.

CONCLUSION:
Female pronoun usage reflects the increasing role of women in medicine. Analysis shows the trend from a less regulated field to one of increasing outside influence. “Physician Woes” have increased and likely contribute to physician burnout, which is on the rise.
Variations in Cervical Cytology Testing Among Women of Different Ethnicities [29G]
Authors: Martingano Daniel , Renson Audrey , Martingano Francis X. 
Published: May 2017

INTRODUCTION:
Current information about ethnic differences in the progression and regression of intraepithelial lesions on cervical cytology is undefined, with existing studies looking solely at ethnic differences in compliance with follow-up and treatment. The purpose of this study was to investigate variation in progression and regression of cervical cytology screening results among an ethnically diverse population.

METHODS:
A retrospective review of was conducted for women receiving cervical cytology evaluation from January 1, 2006 through September 30, 2015. Differences in intraepithelial lesion diagnoses on cervical cytology for patients were reviewed. We fit Markov multi-state models to estimate self-reported race/ethnicity-specific expected wait times and hazard rates for each possible regression and progression, and compared a model with race to an intercept-only model using a chi-square likelihood ratio test.

RESULTS:
The sample consisted of 7635 patients, with mean baseline age 34±12, and was 31% Hispanic, 26% White, 17% Black, and 9% Asian, Middle Eastern or other. We estimated a total of 24 hazard ratios and 95% confidence intervals comparing rates of transition to and from ASCUS, ASCH, LGSIL, and HGSIL, for the race/ethnicity categories of Black, Hispanic, and a category for Asian, Middle Eastern, or other, compared to White. The model including race fit significantly better than the intercept-only model (p < 0.001). Visual inspection of expected wait time curves indicated that Black and Hispanic women had a slower progression as well as a slower regression.

CONCLUSION:
Preliminary analysis suggests that the progression/regression of precancerous lesions on cervical cytology may behave differently among women of different ethnicities.
How Has the FDA Morcellation Warning Affected Rates of Minimally Invasive Hysterectomy? [30G]
Authors: Saadat Saba , Arden Deborah 
Published: May 2017

INTRODUCTION:
In 2014 the FDA issued a warning against the use of laparoscopic power morcellation in the majority of women undergoing myomectomy and hysterectomy for the treatment of fibroids, citing the risk of dissemination of an occult malignancy. Since the FDA statement, many institutions have banned or restricted the use of power morcellators.

METHODS:
This is a retrospective time-series analysis on all the hysterectomies performed for benign indications at Southern California Kaiser Foundation Hospitals between April 17, 2014 and April 17, 2016. Rate of abdominal vs. minimally invasive hysterectomies, estimated blood loss, length of operation and hospital stay, major post-operative complications, and hospital re-admission were compared in the one year before and the second year after the FDA warning.

RESULTS:
This study included total of 12,565 hysterectomies. Compared to one year before, there was a 5% increase in the rate of hysterectomies performed via laparotomy after the FDA warning (p < 0.001). There was no increase in the estimated blood loss, operative time, length of hospital stay, rate of re-admission, and post-operative complications (except pulmonary embolism). Similar results were obtained when sub-analysis was performed for hysterectomies with fibroid uterus as an indication for surgery.

CONCLUSION:
There was an increase in the rate of laparotomy for hysterectomy after the FDA morcellation warning. Despite this relative increase, there is no significant increase in the rate of immediate (30 day) post-operative complications or length of operation or hospital stay. This study did not assess parameters such as length of recovery or pain after surgery.
Diagnostic Accuracy of Transvaginal Sonography for Abnormal Uterine Bleeding [31G]
Authors: Vasquez Diego , Patel Marcia Klein , Scioscia Eugene 
Published: May 2017

INTRODUCTION:
The prevalence of intrauterine abnormalities in patients with abnormal uterine bleeding is 46%. Historical data gives the transvaginal sonography (TVS) a sensitivity and specificity of 56% and 73% for detecting intracavitary pathology respectively, however the image resolution of the ultrasound machines has improved significantly since those studies. The objective of this study is to calculate the sensitivity, specificity, positive and negative predictive values of TVS.

METHODS:
Retrospective chart review of patients who had a TVS and a subsequent hysteroscopy performed in the operating room at The Western Pennsylvania Hospital. 500 patients were needed for a 95% Confidence Interval of 0.06%

RESULTS:
Between January 2013 and September 2015, 2351 hysteroscopies were performed. Using a randomization software, 500 randomly selected patients that met inclusion criteria underwent chart review. The hysteroscopic findings were: normal cavity (243), endometrial polyp (157), atrophic endometrium (34), submucosal fibroid (25), other (41). We found a sensitivity of 63%, specificity 80.9%, positive and negative predictive values 67.9% and 77.4% respectively, a significant improvement comparing to historical data, however far from the most accurate studies, the sonohysterogram and diagnostic hysteroscopy.

CONCLUSION:
A false positive rate of 11% is still high if the next step in management will be a hysteroscopy performed in the operating room. In the last 2 years 258 hysteroscopies were performed in the operating room with a false positive diagnosis of intracavitary lesion. This results support the current recommendations of performing a sonohysterogram or office hysteroscopy after a TVS finding of intracavitary pathology.
A Unique Presentation of an Accessory Cavitated Uterine Mass: A Case Report [33G]
Authors: Wiltshire Ashley , Bright Frederick 
Published: May 2017

INTRODUCTION:
An accessory cavitated uterine mass (ACUM) is defined as an isolated mass lined by functional endometrium and encapsulated by smooth muscle. The typical clinical presentation is age less than 30 years old, severe dysmenorrhea, and chronic pelvic pain. ACUM is considered to be a rare diagnosis. However, this pathology may be less rare and more commonly misdiagnosed than originally believed.

METHODS:
The clinical case was analyzed and followed with a literature review.

RESULTS:
The patient is a 28-year-old G2P1011 who presented with shortness of breath and abdominal distention. Imaging revealed a 15 cm x 13.9 cm x 14.7 cm complex pre-sacral mass, severe ascites, and pleural effusion. Her pre-operative diagnosis was Meigs syndrome. Final surgical pathology of the mass confirmed it to be an ACUM. Post-operatively, there was complete resolution of the ascites and pleural effusion.

CONCLUSION:
A high index of suspicion for ACUM followed by early surgical management is imperative for proper diagnosis and management. Pleural effusion and ascites may be clinical indications of ACUM and should lower one's threshold to consider ACUM on the differential diagnosis.
Utility of Measuring TSH Levels in Patients Presenting With Abnormal Uterine Bleeding [34G]
Authors: Summers Caroline , Johnson Isaiah 
Published: May 2017

INTRODUCTION:
Abnormal uterine bleeding (AUB) affects 9 to 14% of reproductive aged women. Previous studies have demonstrated an increased prevalence of menstrual abnormalities in patients with thyroid disease. The American College of Obstetricians and Gynecologists recommends thyroid stimulating hormone (TSH) screening in patients with AUB. There, however, is no published data evaluating the prevalence of thyroid disease among women presenting with AUB. The purpose of this study is to determine the prevalence of thyroid disease in patients with AUB presenting to a gynecology clinic.

METHODS:
This is a retrospective case series of patients aged 18 to 50 years that presented with AUB to the gynecology clinic. Patients were identified through review of the electronic medical record (EMR) from January 2012 to June 2016. Two hundred and three patients meeting study criteria for inclusion were analyzed and the prevalence of abnormal TSH was calculated.

RESULTS:
Thirteen patients (6.4%) were identified with abnormal TSH values. These patients were diagnosed though subsequent testing with subclinical hyperthyroidism (3.4%), subclinical hypothyroidism (0.49%), clinical hypothyroidism (0.49%), and clinical hyperthyroidism (0.49%). The majority of these patients did not have an established diagnosis for AUB (AUB-N) in the EMR. Five patients (38.5%) were diagnosed with AUB-O (ovulatory dysfunction).

CONCLUSION:
In this patient population with AUB, the prevalence of thyroid disorders was not increased as compared to the expected prevalence of thyroid disease in general female population. Routine measurement of TSH identified few patients with clinical thyroid disease.