bluuebunny/crossref_metadata_2025_split huggingface dataset:
Provider Differences in Outcomes of Low-Risk TOLAC Patients: Comparing Midwifery and Obstetrician Management [34H]
Authors: Fore Matthew S. , Allshouse Amanda , Carlson Nicole S. , Hurt K. Joseph 
Published: May 2017

INTRODUCTION:
Provider management may influence the success of trial of labor after cesarean (TOLAC). This study examined the role of the provider, MD-obstetrician (OB) or certified nurse midwife (CNM), in explaining differences in unplanned cesarean delivery (uCD) during TOLAC for low-risk women.

METHODS:
We performed a secondary analysis of a cohort prospectively enrolled from 2005 to 2012 at the University of Colorado Hospital. We compared the probability of uCD by provider type in logistic regression and in multivariable modeling, adjusting for maternal, pregnancy, fetal, and neonatal covariates. Results are odds ratios with 95% confidence intervals. Maternal and combined neonatal-maternal adverse morbidity composites were compared by provider type.

RESULTS:
216 OB-managed versus 286 CNM-managed deliveries were similar in average maternal age, BMI, and proportion of race/ethnicity and were not significantly different for risk of uCD (0.78, 0.45-1.37). Adjusting for onset of labor, race/ethnicity, obstetric history, and recurring indication showed no significant difference in risk of uCD between OB- versus CNM-managed deliveries (0.60, 0.32-1.12). While OB- versus CNM-managed deliveries did not significantly differ in overall adverse composite outcome (1.24, 0.81-1.90), odds of maternal morbidity were greater in OB-managed deliveries (1.62, 1.02-2.56).

CONCLUSION:
There is no significant difference in unplanned cesarean between provider types, suggesting that provider type alone does not predict TOLAC success in low-risk women but may predict differences in maternal morbidity in this specific population. Further investigation of individual between-provider differences rather than provider groups could help target interventions to reduce uCD and increase TOLAC success in the United States.
Put Your Oxygen Mask on First - Perinatal Psychiatric Emergencies: A Reproductive Psychiatrist’s Perspective [1I]
Authors: Rodriguez-Cabezas Lisette , Clark Crystal , Yang Amy , Pendergrast Tricia , Miller Emily , Wisner Katherine 
Published: May 2017

INTRODUCTION:
There is not much data on the management of perinatal psychiatric emergencies in the current literature despite the increased attention that they have received in the media recently. This presentation will provide the data that is currently available, including a retrospective analysis of our own institution, and provide guidelines to direct clinical care.

METHODS:
A literature search was performed to analyze all of the available published data on perinatal psychiatric emergencies. Also, a retrospective data analysis was performed at our own university hospital looking at use of restraints, psychotropic medications, and or both in the treatment of pregnant women who presented to the emergency department. Data on chief complaint, demographics, and final disposition were also analyzed.

RESULTS:
The data is still being analyzed but a good proportion received psychotropics and went on to be psychiatrically hospitalized. Restraints were a rare event. According to the literature search, some conclusions can be drawn as to which medications and treatments may be less risky for certain emergencies. Of note, there were a considerable number of patients whose chief complaint was medical but ultimately were psychiatrically assessed and admitted.

CONCLUSION:
This is, to our knowledge, the first retrospective analysis of emergency room data on the management of perinatal psychiatric emergencies. These data will be the basis for future research in this field which deserves more attention due to the dearth of information currently available.
Obstetrics and Gynecology Residents’ Assessment of Clinical Genetics Competence [3I]
Authors: Adjei Naomi , Friedman M. Alexandra , Wenstrom Katharine 
Published: May 2017

INTRODUCTION:
Although OB-GYNs must increasingly deal with genetic issues, the adequacy of their education in genetics is unknown. We investigated residents’ sources of genetics information and their perceived knowledge and comfort level with 13 established core genetics competencies, as well as common genetics issues.

METHODS:
A 28 question survey was generated to query resident education generally and genetics education specifically. An invitation was sent to all ACGME Program Directors, asking them to forward the online survey to their residents. Data was collected and analyzed using Qualtrics Software.

RESULTS:
195 residents from 51/292 programs (17.5%) participated in the study. Residents uniformly reported high perceived importance of counseling patients about specific genetic issues: Fragile X syndrome (171, 99%), cancer genetics (172, 100%), prenatal screening (170, 99%), and interpreting cell free DNA results (168, 98%). However, a majority of residents reported having good/very good knowledge level of only 3 of 13 genetics core competencies: chromosome abnormalities (87, 51%), prenatal screening testing (68, 40%) and taking family history (81, 47%). The majority reported fair, poor, or very poor knowledge of preconception counseling; multifactorial, mendelian, and non-mendelian inheritance; single gene disorders; population genetics; screening at-risk populations; cancer and molecular genetics; and constructing a pedigree. Residents reported obtaining clinical genetics information primarily from guidelines and practice bulletins (108, 63%), although 30% (52) of residents reported no good source of clinical genetics information.

CONCLUSION:
OB-GYN residents perceive their knowledge of genetics to be inadequate, and are unaware of appropriate sources for genetics information. Resident genetics education must be improved.
Clitoral Restoration After Female Genital Mutilation [4I]
Authors: Henning Harold 
Published: May 2017

INTRODUCTION:
To see if clitoral restoration is a valid, repeatable and acceptable procedure for women who have had female genital mutilation in the past.

METHODS:
Retrospective review of 25 patients that voluntarily underwent the clitoral restoration procedure.

RESULTS:
Twenty-five patients underwent clitoral restoration from July 2012 to October 2015. Fourteen responded to follow up questioning: Of those that responded 13 out of 14 (93%) said they were glad they had the surgery done and 11 out of 14 (79%) said that their sense of pleasure had been restored. Overall, if the non-respondents were considered as a negative response then 13 out of 25 (52%) were glad and 11 out of 25 (44%) had pleasure after having the surgery performed.

CONCLUSION:
FGM clitoral reconstruction appears to be a valid surgical procedure to consider for women who have had FGM done to them against their will.
Trends in Social Media and Mobile Applications Among Medical Students Entering Obstetrics and Gynecology [7I]
Authors: Purusothaman Vaishnavi , Ramsey Patrick S. , Miller Katherine , Page-Ramsey Sarah M. 
Published: May 2017

INTRODUCTION:
Increasing popularity of social media and mobile devices has greatly impacted medicine. The potential implications in patient care have resulted in formal policies in many healthcare institutions. We sought to identify trends in social media, use of mobile technology, and exposure to social media training and policies among medical students entering OBGYN.

METHODS:
We surveyed all medical students attending the national American College of Obstetricians and Gynecologists Annual Medical Student Course from 2012-2016 regarding social media use, use of mobile medical applications, and prevalence of medical school social media policies and training. Descriptive statistics and Chi-squared analyses were performed as appropriate.

RESULTS:
742 of 815 (91%) students from 48 states responded. Most (68%) were third-year students, women (84%), and age 20-30 years (92%). Social media use increased from 81% to 94% of students (p=0.0001). Facebook™ was the most commonly used site. Mobile medical applications were used by 92% of students; 89% thought medical applications were helpful in learning. The most commonly used applications were Epocrates™ (77%) and UpToDate™ (76%). Medical school policies and training in social media increased from 23% to 37% (p=0.0065) and 35% to 57% (p=0.0004) respectively.

CONCLUSION:
Medical students planning to pursue OBGYN report increasing use of social media and medical school policies and training in social media. Mobile applications are frequently used as a valued method of learning in the clinical setting. These trends will likely impact learning and patient care, and can be useful in developing educational curricula and communication platforms for our next generation of OBGYNs.
Bright Pink’s “Assess Your Risk” Patient Survey: Feasibility of Utilizing Social Media for Research [12I]
Authors: Lindner Deborah , Vasic Jelena 
Published: May 2017

INTRODUCTION:
Recent studies have highlighted strengths of utilizing social media to recruit for and conduct research when compared to traditional methods. Our study aims to confirm the feasibility of using social media to recruit large numbers of research participants to Bright Pink’s digital “Assess Your Risk” breast and ovarian cancer risk assessment survey.

METHODS:
Data was obtained from participants driven by Facebook advertising to the “Assess Your Risk” survey between April 1st and September 30th, 2016. Advertisements appeared on the pages of Facebook users whose profiles matched the following inclusion criteria: female, ages 18-45, with interest in either breast and ovarian cancer topics, social impact brands, or fitness.

RESULTS:
The Facebook advertisements garnered 6,865,108 impressions, defined as the number of women exposed to the advertisements. 192,546 of those exposed to the advertisements clicked on them, and of those, 84.3%, or 162,132 women, went on to complete the 19 question assessment quiz. Cost per completion was $0.16 compared to email ($15-25) or mail ($25-35) surveys.

CONCLUSION:
Internet recruiting through social media has been an underused strategy in attracting individuals in health research. The response rate of the Assess Your Risk survey tool shows the potential to harness data collection to conduct meaningful and cost-effective research through the use of social media advertising.
Palliative Care Rotations in Obstetrics and Gynecology, Internal Medicine, and Family Medicine Residency Programs [14I]
Authors: Bazzi Mohamad , Tyagi Sarika , Bazzi Ali , Uppal Shitanshu 
Published: May 2017

INTRODUCTION:
To determine the number of obstetrics and gynecology, internal medicine, and family medicine residency training programs with mandatory palliative care rotations.

METHODS:
We included internal medicine, family medicine, and obstetrics and gynecology programs listed on the Fellowship and Residency Electronic Interactive Database. Program information such as the number of residents per year, geographic location and monthly block schedule for each program were obtained. If the block schedule explicitly mentioned mandatory palliative care rotation for at least two weeks, programs were categorized as: mandatory palliative care program.

RESULTS:
Overall, 12.4% (146/1,177) programs had mandatory rotation as part of the residency training. Rates of mandatory palliative care rotation were highest amongst the programs in the West-Pacific (29.2%) and lowest for the West-Mountain (3.5%) residency programs. Internal medicine programs had higher mandatory palliative care rotations compared to Family Medicine (17.6% vs 14.3%, P=.048). Obstetrics and Gynecology had the lowest rate at 0.8%. From these programs, 16.2% (2,181/13,434) of the graduating residents each year had mandatory palliative rotation exposure.

CONCLUSION:
Our findings highlight the lack of focus on primary palliative care training. Despite recommendations from the Institute of Medicine, based on our analysis, majority of graduate medical training programs do not incorporate palliative care in the curriculum. Incorporating palliative care training with other mandatory subspecialty trainings rotations (e.g. cardiology or oncology) would be an important step in this direction to assure the delivery of high-quality end-of-life care.
Patient Information About Zika Virus and Perinatal Risks on State Health Department Websites in the United States [17I]
Authors: Menchaca Ryan , Page-Ramsey Sarah M. , Rodriguez Emma , Gray Jordan , Ireland Kayla , Ramsey Patrick S. 
Published: May 2017

INTRODUCTION:
Zika virus infection is an emerging health threat in pregnant women. It is important that obstetric patients or women considering pregnancy can access up-to-date information about Zika. Our objective was to evaluate the availability of patient-level information about the Zika virus and perinatal risks on state health department websites in the United States and its territories.

METHODS:
We reviewed each U.S. state, District of Columbia and its territories (Puerto Rico, Guam, US Virgin Islands, American Samoa, North Marianas Islands) health department websites and abstracted patient information available on the Zika virus, pregnancy risks, prevention measures, mosquito repellants, sexual transmission, endemic areas, and travel guidance. In cases where information did not appear immediately on the main webpage, an internal search of the site using the term “Zika” was performed.

RESULTS:
96.4% of the 56 state/territory health department websites contained patient information about Zika virus. Information was more commonly found on state websites than on territories websites (98.0% vs 60.0%). Among the state/territory websites with any Zika information, specific information noted details about the Zika virus (98.1%), pregnancy risks (84.6%), risk of microcephaly (76.9%), sexual transmission (82.7%), mosquito repellant use (71.2%), travel avoidance (84.6%), and Zika endemic areas (90.1%).

CONCLUSION:
Patient access to Zika virus information is available on most US state and territory health department websites, though less common on territory sites. Because patients need to easily access educational information about Zika virus infection in pregnancy, we should aim to have this information available on all state and territory sites.
Innovative Educational Tool to Enhance Hysteroscopy Learning [18I]
Authors: Hammer Karissa , Fogg Louis , Tam Teresa 
Published: May 2017

INTRODUCTION:
It has been established that hands-on training is known to improve resident learning. However, few have investigated lecture content and improvement of resident education on hysteroscopic instrumentation and assembly. This study evaluates a standardized educational curriculum in hysteroscopy for obstetrics and gynecology (OB/GYN) residents.

METHODS:
A standardized hysteroscopic curriculum was developed in line with American College of Obstetricians and Gynecologists hysteroscopy training guidelines. The curriculum consists of a one-hour lecture followed by a hands-on hysteroscopic instrumentation session. Participants were given a pre-test prior to the lecture and a post-test after subsequent lectures. Residents from three different institutions in Chicago, Illinois from 2013 to 2016 were tested. Instrument assembly was graded by time spent for task completion.

RESULTS:
Repeated measures analysis of variance was used to assess data points, pre and post test scores compared by training year and overall improvement. There was a statistically significant score difference in each level of training from pre to post-test. This difference was linear, magnitude of effect the same on each training level (N=29, P value 0.035). On average, scores improved by 14%. Hysteroscopic assembly time decreased by 2.45 minutes (N=14, P value 0.03). Improvements did not change with level of training but were only related to exposure to lecture content.

CONCLUSION:
An established curriculum made significant change in residents’ knowledge of hysteroscopy and instrumentation as demonstrated by improved hysteroscopic assembly times and post-test scores. This tool demonstrated an impact in multiple residency programs and can be more widely applied to aid resident training in hysteroscopy.
Identification and Rating of Medical Translator Mobile Applications Using the APPLICATIONS Scoring System [32I]
Authors: Khander Amrin , Farag Sara , Chen Katherine 
Published: May 2017

INTRODUCTION:
With an increasing number of limited-English proficiency (LEP) patients, many health care providers are turning to medical translator applications (apps) for assistance. However, no known published reviews or evaluations of these apps exist. Our objective was to identify and rate medical translator apps using the APPLICATIONS scoring system.

METHODS:
A list of apps was identified from the Apple iTunes and Google Play stores using the search term, “medical translator.” Apps not found on two different searches, not in an English-based platform, not used for translation, or not functional after purchase were excluded. The remaining apps were rated using the APPLICATIONS scoring system, which includes both objective and subjective criteria and evaluation of special features such as audio, microphone, and keyboard capabilities. App comprehensiveness was a weighted score defined by the number of non-English languages included in each app relative to the proportion of non-English speakers in the US.

RESULTS:
524 apps were initially found and 26 (9.2%) apps from the Apple iTunes store and 20 (8.2%) apps from the Google Play store remained after applying exclusion criteria. These apps were categorized as preset medical phrases (23 apps), medical dictionaries (16 apps), and general language translators (6 apps). The highest scoring app available on both platforms was Universal Doctor Speaker. Canopy scored highly in iTunes whereas Vocre Translate scored highly in Google Play.

CONCLUSION:
Using the APPLICATIONS scoring system, we have identified and rated medical translator apps that could prove useful to providers in caring for LEP patients.
Identification and Evaluation of Fetal Heart Rate Monitoring Mobile Applications [33I]
Authors: Soffer Marti , Chen Katherine 
Published: May 2017

INTRODUCTION:
Regulation of medical applications (apps) has not been rigorous, yielding greater concern for inaccurate medical apps. This study aimed to identify mobile apps for fetal heart rate monitoring (FHM) and to evaluate their accuracy.

METHODS:
A list of FHM apps was found in the Apple iTunes stores using a comprehensive list of search terms. After excluding apps irrelevant to this study, all unique apps were downloaded and evaluated for request for personal information, necessary purchase of an accessory item, presence of disclaimer regarding medical advice, and accuracy of medical content. Those apps that did not require personal information, did not need purchase of an accessory item, and were not duplicates, were tested for accuracy and misinformation.

RESULTS:
A total of 30 unique FHM apps were generated. Of these apps, one required an in-app purchase to use, 6 apps requested personal information, and 4 apps required purchase of an accessory device and thus were not further evaluated. Of the 19 remaining, all (100%) of the applications were unable to detect the adult heart rates of the authors. Five apps were duplicates, 6 lacked disclaimers regarding medical use, and 5 provided false information.

CONCLUSION:
Identification of FHM apps that do not require personal information nor purchase of accessory item revealed that all apps were inaccurate. In addition, many apps did not provide a disclaimer and/or contained false information. Health care providers should understand the problems with these FHM apps, and educate their patients on the inaccuracies and potential dangers of the use of these applications.
A Rare Case of Primary Invasive Papillary Adenocarcinoma of Vulvar Lesion [4J]
Authors: King Robinette 
Published: May 2017

INTRODUCTION:
Vulvar cancer accounts for approximately 5% of all female genital malignancies and is commonly recognized as a disease of postmenopausal women. The vast majority of vulvar carcinomas are of the squamous cell type (90%) with primary vulvar adenocarcinomas ranking among the rare gynecological malignancies, comprising less than 0.1% of the cases. This case report is a primary vulvar adenocarcinoma and discusses the diagnosis and the treatment of this unusual and uncommon neoplasm.

METHODS:
The clinical case was analyzed followed by a literature review on papillary adenocarcinoma of the vulvar.

RESULTS:
A 53-year-old postmenopausal African-American female presented with 1-year history of enlarging, otherwise asymptomatic left vulvar mass. A flesh colored 3 × 2 cm mobile, nodular lesion was noted on left anterior labia majora. An excisional procedure was completed. Final pathology revealed the skin to be benign with cyst wall and contents revealing moderately differentiated invasive papillary adenocarcinoma. Stains of the neoplastic cells were positive for p53 immunostain. Follow-up clinical evaluation did not demonstrate evidence of metastatic disease and the recommendations of the monthly multidisciplinary meeting was for ipsilateral lymph node dissection and modified radical vulvectomy of tumor bed. The patient declined diagnosis and recommended treatment.

CONCLUSION:
Adenocarcinomas of the vulva are exceedingly rare, making diagnosis and management difficult for pathologists and clinicians. As a result literature is very limited. This report will allow for further advancement in regards to the diagnosis and treatment of this unusual and uncommon neoplasm.
Using the Rothman Index to Identify Oncology Patients at Risk for Postoperative Readmission [6J]
Authors: Butz Anh , El Alam Michel , Irvin William , Stovall Dale 
Published: May 2017

INTRODUCTION:
The Rothman Index (RI), a composite score from 0 to 100, is a previously validated, continuously computed score derived from over 50 clinical measures that assesses a patient’s clinical status. It has been used as a prognostic indicator in the ICU setting and can be incorporated into the EMR. This study was designed to determine its utility in assessing readmission rates in postoperative gynecologic oncology patients.

METHODS:
In this pilot retrospective case-control study, gynecologic oncology surgical patients readmitted within 30 days of discharge (cases) were matched 1:2 by procedure, diagnosis, age and comorbidities to non-readmitted gynecologic oncology surgical patients (controls). All procedures were performed at one center by a single surgeon. RI values were obtained immediately postoperative (RI-i) and before discharge (RI-f), and the difference between these values was calculated (RI-d). RI’s were compared between cases and controls using R software.

RESULTS:
A total of 24 cases were matched to 48 controls. The mean age was 56. RI-f was significantly different between groups and predictive of readmission (P = 0.017). An RI-f of 58 or less was associated with at least 51% likelihood of readmission. Cases and controls did not differ significantly based on RI-i or Ri-d, and they were similar with respect to risk factors including diabetes, smoking, and BMI.

CONCLUSION:
The RI value on the day of discharge is helpful in identifying postoperative gynecologic oncology patients at increased risk for readmission. Delaying discharge for patients with an RI below a designated threshold may reduce readmission rates.