bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postpartum Contraception Acceptance and Readiness for Long Acting Reversible Contraception [40I]
Authors: Williams Heather , Goad Lindsay , Treloar MacKenzie , Mejia Rachel , Stockdale Colleen , Hardy-Fairbanks Abbey 
Published: May 2017

INTRODUCTION:
Determine the optimal time to discuss and formulate a plan for postpartum contraception by using motivational interviewing and stages of change. Determine responses associated with uptake and adherence to long acting reversible postpartum contraception (LARC).

METHODS:
Adult women between gestational ages of 25 0/7 and 35 6/7 weeks seeking prenatal care and plans to delivery at our facility were offered to participate in the study. Subjects completed surveys querying readiness, capability and confidence in discussing and committing to a postpartum contraceptive plan at a single prenatal visit and again during their postpartum hospitalization. Subjects received a phone survey at 4–6 months postpartum.

RESULTS:
243 women recruited from February to July 2015. 63% of patients responded the best time for contraception discussion was the 2nd or 3rd trimester; 90% planned to start contraception after delivery. More women reported prenatally and postpartum that they felt capable to choose LARC (85% v. 87%; P < .0001) compared to other forms of contraception. Additionally more women reported prenatally and postpartum that they felt ready to choose LARC as their postpartum contraception (74% v. 84%; P < .0001) compared again to other forms of contraception. Women who reported being more ready or capable were more likely to choose LARC and to be using that method at 4–6 months postpartum.

CONCLUSION:
Women report higher levels of readiness and capability to choose and discuss contraception postpartum than prenatally, however, high rates were seen throughout. More women choose LARC when they endorse readiness, confidence and capability to choose a contraceptive option.
Impact of Fentanyl Use on Maintenance Therapy During Pregnancy [40O]
Authors: Belcher-Obejero-Paz Alexandra A. , Yarrington Christina , Saia Kelley 
Published: May 2017

INTRODUCTION:
Little is known about the impact of fentanyl abuse on pregnancy care. We sought to investigate whether there is a difference in the pattern of opioid maintenance requirement among pregnant women who test positive for fentanyl at their initial titration compared to those who test negative.

METHODS:
We conducted a retrospective cohort review of pregnant patients admitted for initial buprenorphine (STX) or methadone (MTD) maintenance dosing from April 2015 to December 2015. Demographic characteristics and obstetrics outcomes in the fentanyl positive and fentanyl negative cohorts were compared using a student’s t-test or chi square as appropriate. We compared mean MTD or STX dose required among fentanyl positive compared to fentanyl negative patients using a student’s t-test. The small sample size allowed analysis only of crude data.

RESULTS:
Sixteen pregnant patients were admitted for initial STX or MTD maintenance titration. Seven of these patients (43.7%) tested positive for fentanyl on admission. There were no differences in baseline demographics or obstetric outcomes in the two cohorts. There was not a significant differences in dose requirement for fentanyl positive versus fentanyl negative patients (MTD: 45 mg vs 47 mg, p=0.68; 9mg vs 10 mg STX: p=0.12). Average maintenance dos at delivery was higher for fentanyl abusers on MTD maintenance compared to fentanyl non-abusers (90 mg vs 55 mg, p=0.04).

CONCLUSION:
There was no significant difference in MTD or STX requirement at initial titration, but the fentanyl positive cohort maintained on MTD did require a significantly higher dose by delivery.
A Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) Relates to Gestational Diabetes, Glycemic Control [1K]
Authors: VanWinden Kristi , Montoro Martin , Korst Lisa M. , Ouzounian Joseph G. 
Published: May 2017

INTRODUCTION:
Current methods of evaluating glycemic control in gestational diabetes (GDM) are difficult to standardize within research protocols. The study objective was to validate the use of the HOMA-IR assessment in pregnancies with and without GDM as an indicator of the degree of insulin resistance and as a potential tool for evaluating the response to interventions for GDM aimed at improving insulin sensitivity.

METHODS:
Prospective cohort study investigating the utility of the HOMA-IR for measuring insulin resistance, beta-cell function, and GDM severity in pregnant women. Each patient had glucose and insulin levels drawn after a minimum 8 hour fast. These values were used to calculate HOMA-IR using published computer models. Measurements were taken between 28 and 34 weeks of gestation in women with diet-controlled gestational diabetes and non-GDM controls, matched for maternal age, gestational age, and body mass index.

RESULTS:
HOMA-IR levels were calculated prospectively in 134 women with diet-controlled gestational diabetes and 23 controls without GDM. HOMA-IR was significantly greater in the GDM group compared with non-GDM controls (mean 2.53+1.01 versus 2.02+0.90, p=0.0216) and in women with GDM who ultimately required medical therapy for glucose control compared with those who remained diet-controlled (1.42+0.952 versus 2.95+2.680, p < 0.0001).

CONCLUSION:
HOMA-IR is a simplified measure of insulin resistance and may predict both which pregnant women are at risk for GDM and which patients with GDM are most likely to require medical therapy. HOMA-IR is a potentially valuable tool in studies of interventions for GDM requiring a marker of insulin resistance.
HPV Vaccination Rates Amongst Academic Based Gynecology Clinics [1E]
Authors: Jackson-Bey Tia , Lambert Tashima , Gamble Charlotte , Patterson Latoya , Jones Monica 
Published: May 2017

INTRODUCTION:
The Human Papilloma Virus (HPV) vaccine for prevention of cervical cancer is recommended for all females aged 11-26. Inequities exist in vaccination rates, with lower rates of HPV vaccination among minorities and women living in southern states. Within Duke University Medical center, these statistics are unknown.

METHODS:
This is a retrospective chart review. Data was collected for the month of January 2015 from three Duke based gynecology practices, a resident staffed clinic, and two private Duke affiliated practices. Primary outcome is initiation of HPV vaccination in women aged 11-27. Secondary outcomes include differences in vaccination rates by age, race, ethnicity, practice, and insurance status as well as completion of the vaccination series.

RESULTS:
There were 254 eligible patients. Of those, 15.7% (n=40) were vaccinated. Insurance coverage was high in this population, 94%. Vaccination rates differed by clinic, ranging from 7.6-23% amongst the three practices with vaccination rate in the resident clinic being the lowest. Hispanic and uninsured women were the least likely to be vaccinated.

CONCLUSION:
There is an overall low rate of HPV vaccination within gynecology clinics at Duke University. The majority of this population has medical insurance. Barriers to vaccination include Medicaid criteria for coverage of the vaccination. Interventions should be focused on increasing physician knowledge of the need for this effective vaccine, specifically for racial/ethnic minorities as well as lobbying for greater coverage of the vaccination by Medicaid. The study period has been expanded to 1 year to compare these rates over a longer period of time.
Preoperative Cognitive Performance and Postoperative Delirium Are Independently Associated With Future Dementia in Older People Who Have Undergone Cardiac Surgery: A Longitudinal Cohort Study*
Authors: Lingehall Helena Claesson , Smulter Nina S. , Lindahl Elisabeth , Lindkvist Marie , Engström Karl Gunnar , Gustafson Yngve G. , Olofsson Birgitta 
Published: May 2017

Objective:
To investigate if postoperative delirium was associated with the development of dementia within 5 years after cardiac surgery.

Design:
Longitudinal cohort study.

Setting:
Cardiothoracic Division, Umeå University Hospital, Sweden.

Patients:
Patients aged 70 years old or older (n = 114) scheduled for routine cardiac procedures with cardiopulmonary bypass without documented dementia were enrolled in 2009.

Intervention:
Structured assessments were performed preoperatively, 1 and 4 days after extubation, and 1, 3, and 5 years postoperatively.

Measurements and Main Results:
Patients were assessed comprehensively, including cognitive and physical function, coexisting medical conditions, demographic characteristics, and medications. Diagnoses of delirium, depression, and dementia were made according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision criteria. During the 5-year period, 30 of 114 participants (26.3%) developed dementia. Postoperative delirium had occurred in 87% of those who later developed dementia. A multivariable logistic regression model showed a lower preoperative Mini-Mental State Examination score (p < 0.001; odds ratio, 0.68; 95% CI, 0.54–0.84) and the occurrence of postoperative delirium (p = 0.002; odds ratio, 7.57; 95% CI, 2.15–26.65) were associated with dementia occurrence.

Conclusions:
Our findings suggest that older patients with reduced preoperative cognitive functions or who develop postoperative delirium are at risk of developing dementia within 5 years after cardiac surgery. Cognitive functions should be screened for preoperatively, those who develop postoperative delirium should be followed up to enable early detection of dementia symptoms, and management should be implemented.
Paradoxical Impact of Ileal Pouch-Anal Anastomosis on Male and Female Fertility in Patients With Ulcerative Colitis
Authors: Pachler Frederik R. , Brandsborg Søren B. , Laurberg Søren 
Published: May 2017

BACKGROUND:
Birth rates in males with ulcerative colitis and ileal pouch-anal anastomosis have not been studied.

OBJECTIVE:
This study aimed to estimate birth rates in males and females with ulcerative colitis and study the impact of ileal pouch-anal anastomosis.

DESIGN:
This was a retrospective registry-based cohort study that was performed over a 30-year period.

SETTINGS:
Records for parenting a child from the same period were cross-linked with patient records, and birth rates were calculated using 15 through 49 years as age limits. All data were prospectively registered.

PATIENTS:
All patients with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis between 1980 and 2010 were identified in Danish national databases.

MAIN OUTCOME MEASURES:
The primary outcomes measured were birth rates in females and males with ulcerative colitis and ulcerative colitis with ileal pouch-anal anastomosis.

RESULTS:
We included 27,379 patients with ulcerative colitis (12,812 males and 14,567 females); 1544 had ileal pouch-anal anastomosis (792 males and 752 females). Patients with ulcerative colitis have slightly reduced birth rates (males at 40.8 children/1000 years, background population 43.2, females at 46.2 children/1000 years, background population 49.1). After ileal pouch-anal anastomosis, males had increased birth rates at 47.8 children/1000 years in comparison with males with ulcerative colitis without ileal pouch-anal anastomosis (40.5 children/1000 years), whereas females had reduced birth rates at 27.6 children/1000 years in comparison with females with ulcerative colitis without ileal pouch-anal anastomosis (46.8 children/1000 years).

LIMITATIONS:
Only birth rates were investigated and not fecundability. Furthermore, there is a question about misattributed paternity, but this has previously been shown to be less than 5%.

CONCLUSIONS:
Ulcerative colitis per se has little impact on birth rates in both sexes, but ileal pouch-anal anastomosis surgery leads to a reduction in birth rates in females and an increase in birth rates in males. This has clinical impact when counseling patients before ileal pouch-anal anastomosis surgery.
Bowel Sounds Are Not Associated With Flatus, Bowel Movement, or Tolerance of Oral Intake in Patients After Major Abdominal Surgery
Authors: Read Thomas E. , Brozovich Marc , Andujar Jose E. , Ricciardi Rocco , Caushaj Philip F. 
Published: May 2017

BACKGROUND:
Auscultation for bowel sounds has been advocated by some clinicians as a method to determine the resolution of postoperative ileus.

OBJECTIVE:
Our primary aim was to prospectively evaluate the relationships between bowel sounds and the ability to tolerate oral intake in patients after major abdominal surgery. Secondarily we aimed to evaluate relationships among bowel sounds, flatus and bowel movement, and oral intake.

DESIGN:
This was a prospective, blinded observational study.

SETTINGS:
The study was conducted at Western Pennsylvania Hospital.

PATIENTS:
A total of 124 adult patients undergoing major abdominal surgery were included.

MAIN OUTCOME MEASURES:
Data were collected by medical students blinded to the purpose of the study for 10 days postoperatively or until discharge, including the presence of bowel sounds (auscultation for 1 minute), flatus, bowel movement, and tolerance of oral intake (defined as ingestion of ≥1000 mL/24 h and each subsequent day without vomiting). Associations between paired variables were determined using ϕ coefficient testing.

RESULTS:
The study population consisted of 51 men and 73 women, with a mean age of 64 years (range, 20–92 y). The majority of patients (78/124 (63%)) underwent colorectal resection. The median length of hospital was 6 days. Bowel sounds were not associated with flatus, bowel movement, or tolerance of oral intake throughout the study period. The positive predictive value of bowel sounds in predicting flatus and bowel movement was low in the early postoperative period and remained <25% in predicting tolerance of oral intake throughout the study period. The analysis was repeated, including only those patients undergoing colorectal procedures, and was essentially unchanged. Flatus correlated with bowel movement in the first 6 days postoperation, but neither flatus nor bowel movement was associated with tolerance of oral intake.

LIMITATIONS:
The rate of tolerance of oral intake was relatively modest throughout the study period.

CONCLUSIONS:
Bowel sounds are not associated with flatus, bowel movement, or tolerance of oral intake after major abdominal surgery.
Rationale for Therapeutic Drug Monitoring of Biopharmaceuticals in Inflammatory Diseases
Authors: Paintaud Gilles , Passot Christophe , Ternant David , Bertolotto Antonio , Bejan-Angoulvant Theodora , Pascual-Salcedo Dora , Mulleman Denis 
Published: May 2017

Abstract:
Biopharmaceuticals bring together a number of specific characteristics as compared with other drugs. However, as it is done for most drugs, an individual adjustment of their dose may be necessary. Similar to “chemical” drugs, biopharmaceuticals used in immunoinflammatory diseases have a rather narrow therapeutic range, lack good early clinical or biological marker of response, have variable pharmacokinetics, and their serum concentrations are most often related with response. Monoclonal antibodies have additional specific sources of pharmacokinetic variability. Low concentrations may increase the risks of immunization, plasmapheresis may increase their elimination, and subcutaneous formulations may be associated with decreased adherence. For all these reasons, pharmacokinetic therapeutic drug monitoring may be useful. However, few randomized controlled therapeutic drug monitoring studies have been published. For monoclonal antibodies, a precise definition of the therapeutic concentrations is challenging because of the interindividual variability in their concentration–effect relationship.
Inflammatory Mediators in Xanthelasma Palpebrarum: Histopathologic and Immunohistochemical Study
Authors: Govorkova Maria S. , Milman Tatyana , Ying Gui-Shuang , Pan Wei , Silkiss Rona Z. 
Published: May 2017

Purpose:
To evaluate the expression of inflammatory mediators in xanthelasma palpebrarum.

Methods:
In this retrospective histopathologic case–control study, xanthelasma specimens obtained from the private practice and pathology archives of 1 author (R.Z.S.) were analyzed and compared with the blepharoplasty tissues from age- and sex-matched controls. Paraffin-embedded tissue sections were stained with hematoxylin–eosin and CD3, CD20, CD163, cyclooxygenase-1, inducible nitric oxide synthase, matrix metallopeptidase-9, and myeloperoxidase antibodies. Immunostaining was quantified by light microscopy and with a computerized image analysis system of scanned images.

Results:
Hematoxylin–eosin-stained preparations of xanthelasma specimens demonstrated significantly more intense chronic lymphocytic infiltrate when compared with the control blepharoplasty tissues (p < 0.001). Immunohistochemical studies revealed more intense CD3+ T cell and CD163+ histiocytic infiltrate (11% vs. 5%; p = 0.02 and 28% vs. 5%; p = 0.003, respectively) and increased expression of cyclooxygenase-1 (44% vs. 20% expressing cells; p < 0.001 and 21% vs. 9% strongly expressing cells; p = 0.008) and inducible nitric oxide synthase (43% vs. 26% expressing cells; p = 0.03 and 42% vs. 25% strongly expressing cells; p = 0.02) in xanthelasma specimens compared with control tissues.

Conclusions:
The inflammatory milieu in xanthelasma appears to be analogous to descriptions of the early stages of cardiac atherosclerotic plaque formation. These findings may contribute to the understanding of xanthelasma pathogenesis and to the development of potential targeted therapies.
Transformational Leadership: The Chief Nursing Officer Role in Leading Quality and Patient Safety
Authors: Jones Pam , Polancich Shea , Steaban Robin , Feistritzer Nancye , Poe Terri 
Published: May 2017

Abstract
This department column highlights leadership perspectives of quality and patient safety practice. The purpose of this article is to provide strategic direction for transformational quality and safety leadership as the chief nursing officer (CNO) within the academic medical center environment.
Round Window Application of an Active Middle Ear Implant: A Comparison With Hearing Aid Usage in Japan
Authors: Iwasaki Satoshi , Usami Shin-ichi , Takahashi Haruo , Kanda Yukihiko , Tono Tetsuya , Doi Katsumi , Kumakawa Kozo , Gyo Kiyofumi , Naito Yasushi , Kanzaki Sho , Yamanaka Noboru , Kaga Kimitaka 
Published: May 2017

Objective:
To report on the safety and efficacy of an investigational active middle ear implant (AMEI) in Japan, and to compare results to preoperative results with a hearing aid.

Design:
Prospective study conducted in Japan in which 23 Japanese-speaking adults suffering from conductive or mixed hearing loss received a VIBRANT SOUNDBRIDGE with implantation at the round window. Postoperative thresholds, speech perception results (word recognition scores, speech reception thresholds, signal-to-noise ratio [SNR]), and quality of life questionnaires at 20 weeks were compared with preoperative results with all patients receiving the same, best available hearing aid (HA).

Results:
Statistically significant improvements in postoperative AMEI-aided thresholds (1, 2, 4, and 8 kHz) and on the speech reception thresholds and word recognition scores tests, compared with preoperative HA-aided results, were observed. On the SNR, the subjects’ mean values showed statistically significant improvement, with −5.7 dB SNR for the AMEI-aided mean and −2.1 dB SNR for the preoperative HA-assisted mean. The APHAB quality of life questionnaire also showed statistically significant improvement with the AMEI.

Conclusion:
Results with the AMEI applied to the round window exceeded those of the best available hearing aid in speech perception as well as quality of life questionnaires. There were minimal adverse events or changes to patients’ residual hearing.
Psychometric Evaluation of the Chinese Breast Cancer Prevention Trial Symptom Scale
Authors: Tsai Ching-Fen , Tsai Pei-Shan , Liu Chien-Liang , Lin Yen-Kuang , Ling You-Li , Tseng Ing-Jy , Liao Yuan-Mei 
Published: May 2017

Background:
Women with breast cancer experience a wide spectrum of symptoms after diagnosis and treatment. Symptoms experienced by this specific population might not be fully assessed using available traditional Chinese-language symptom measures.

Objectives:
The aim of this study was to examine the latent constructs and psychometric properties of the Chinese Breast Cancer Prevention Trial (C-BCPT) Symptom Scale.

Methods:
Two hundred women with breast cancer were recruited in Taiwan. Psychometric properties, including construct validity, internal consistency, and test-retest reliability, of the C-BCPT Symptom Scale were tested after translating the original instrument.

Results:
A 21-item C-BCPT Symptom Scale, with 7 extracted factors accounting for 72.26% of the total variance, resulted from an exploratory factor analysis. Construct validity was confirmed by significant correlations between scores on the C-BCPT Symptom Scale and the Taiwan-version Short Form–36 Health Survey (r = −0.49 to −0.53)/Greene Climacteric Scale (r = 0.81). Reliability coefficients for the overall scale/6 extracted factors (Cronbach's α = 0.72–0.88) and test-retest reliability (intraclass correlation coefficients = 0.77–0.94) of the translated instrument were satisfactory, whereas 1 reliability coefficient for 1 extracted factor was inadequate (Cronbach's α = 0.57).

Conclusion:
An interpretable structure with preliminary acceptable psychometric properties of the C-BCPT Symptom Scale was obtained; the C-BCPT can help traditional Chinese-speaking healthcare professionals perform adequate assessments of the symptoms experienced by women with breast cancer.

Implications for Practice:
The C-BCPT Symptom Scale can be used in clinical practice and research to assess symptoms experienced by this specific population or effects of related interventions.
The Relationship Between Body Image, Gender, Subjective Norms, and the Decision to Undergo Preventive Mastectomy Among Arab and Jewish BRCA Carriers
Authors: Kardosh Majeda , Bar-Tal Yoram , Barnoy Sivia 
Published: May 2017

Background:
Carriers for a mutation in BRCA1/2 genes have a high, lifelong risk for developing breast cancer. Preventive mastectomy is considered an effective risk reduction surgery. Many factors might affect the decision to undergo preventive mastectomy, including culture, perceived body image after mastectomy and important others opinion.

Objective:
The aim of this study is to evaluate BRCA mutation carriers’ decision to undergo preventive mastectomy and the relationship between culture, gender, body image, and the decision.

Methods:
The study was a cross-sectional design where Arab and Jewish men and women were requested to imagine that they were/their spouse was a BRCA mutation carrier. The sample consisted of 200 participants, 101 Arab and 99 Jews, included 101 women and 99 men.

Results:
The results show a high intention to undergo preventive mastectomy. Being Arab and having a more positive perception of body image after the surgery were connected to more intention to undergo the surgery. Also, those who intended to choose the surgery considered more the opinions of important others.

Conclusions:
The results point to the importance of partners’ involvement in the decision to undergo preventive mastectomy. Also, important others (relatives, friends, and health caregivers) have an impact on the decision.

Implications for Practice:
Nurses need to consider cultural aspects of patients considering a decision about whether to undergo preventive mastectomy. Understanding the important others who might influence the decision and including them in the decision process are both essential.