bluuebunny/crossref_metadata_2025_split huggingface dataset:
PodCare: Structured Individual Prenatal Care for the Academic Team [22E]
Authors: Damiano Ella A. , Gelb Daniel J. , George Karen , Foster Tina C. , Theiler Regan N. 
Published: May 2017

INTRODUCTION:
Innovative models of prenatal care are needed to improve pregnancy outcomes in the U.S, while improving patient and family experience and lowering costs. We sought to improve upon the traditional prenatal model by structuring visits, coordinating care, and training residents within interprofessional teams.

METHODS:
Attending physicians, resident physicians, associate providers, and clinic staff were split into four “Pods”. Testing and counseling topics were assigned to appropriate visits to create a structured schedule based on gestational age. Weekly Pod meetings provided coordination of care. Data were abstracted retrospectively from Epic for all patients initiating prenatal care in the one year before and after initiation of the new model.

RESULTS:
370 of 1084 patients chose the physician-led group in 2014, compared to only 260 of 1064 in 2013 (P < 0.0005), when other care options included CNM and maternal-fetal medicine care. 113 more births were attributed to the Pods, with a total increase of only 48 prenatal visits. The median number of visits per pregnancy decreased, while quality remained excellent and unchanged by standard obstetric measures. Provider continuity with patients improved, and we observed a three-fold increase in the number of patients presenting for postpartum care. Generalist Ob/Gyn physicians also assumed care of more high risk patients under the model.

CONCLUSION:
The PodCare model is popular with patients, shows promise for improved value by decreasing visits while improving provider continuity and postpartum care, and by providing a robust experience in interprofessional education for residents. Future innovations may include incorporation of formal telehealth visits and biometric sensor data.
Improving Transfer of Patient Care Information Between OBGYNs and Pathology Department [23E]
Authors: Day Robert , Lambert Joelle , Lee Kimberly L. 
Published: May 2017

INTRODUCTION:
The greatest number of medical errors occurs at the time of transfer of patient information. This performance improvement project seeks to improve patient safety by improving the communication between obstetricians/gynecologists and pathologists at single tertiary care facility. Ensuring no errors in the surgical pathology forms ensures that patients receive appropriate and timely pathologic evaluation.

METHODS:
A multidisciplinary team of clinicians and leaders from multiple departments developed educational materials for physician and staff handling pathological specimens, provided individual and group feedback and optimized pathology forms to decrease the amount of errors in communication as pathologic specimens change hands. The number of pathology form errors was identified at the end of every quarter from 2014 to 2016 at Kaiser Permanente Santa Clara.

RESULTS:
Prior to implementation of this project 11 errors were found in a single quarter. Following the implementation of this project, there was a 68% decrease in yearly pathology form errors. This included a steadily quarterly decline that contained 4 quarters without any errors. There was one outlier in the first quarter of 2015 which contained 6 errors.

CONCLUSION:
This project demonstrates that communication between different departments, educational training, directed feedback and optimization of pathology forms can decrease the amount of errors in transfer of patient care information, leading to improved patient care and safety.
Considering Closed Incision Negative Pressure Therapy for Obese Patients with Gynecologic Malignancies [31E]
Authors: Sims Travis , Palavalli Parsons Lavanya H. , Miller David S. , Lea Jayanthi , Carlson Matthew 
Published: May 2017

INTRODUCTION:
In patients with major comorbidities undergoing complex gynecologic surgery, incision management is critical. This retrospective review examined factors associated with incisional complications in patients with multiple comorbidities who underwent laparotomy by the Division of Gynecologic Oncology at our institution.

METHODS:
A retrospective chart review was performed to identify patients who underwent laparotomy for either complex benign gynecologic procedures or gynecologic malignancies from 2013 to July 2016. Descriptive statistics were computed using Fishers Exact Test.

RESULTS:
217 patients were identified who underwent laparotomy; 144 had a gynecologic malignancy and 73 were benign. 42 had a negative pressure VAC system placed. 14 patients with postoperative wound complications were identified. Various risk factors, including body mass index (BMI), age, smoking, diabetes, coronary artery disease, hypertension, cancer, and blood transfusion were examined. Only obesity (BMI greater than 30) was significantly associated with wound complication (p = 0.02; OR 4.3; 95% CI 1.28-14.81). However, only 3 out of the 14 patients that had wound infections had a negative pressure VAC. The average BMI for patients with a negative pressure VAC that did not develop a wound complication was 37.6 plus or minus 9.5, however it was 46.8 plus or minus 11.6 (P less than 0.0001) for those that did.

CONCLUSION:
Obese patients have a higher risk for postsurgical wound complications. Negative pressure VAC therapy could be a preventative measure for obese patients with gynecologic malignancies undergoing laparotomy. Further study is warranted to determine whether closed incision negative pressure therapy reduces the rate of wound complications.
Accuracy of Robotic Cytoreduction Estimates for Ovarian Epithelial Malignancies [33E]
Authors: Geisler John , Manahan Kelly 
Published: May 2017

INTRODUCTION:
Robotic surgery has become the standard for surgical treatment of early cervical and endometrial carcinomas. The purpose was to determine if robotic cytoreduction estimates are accurate.

METHODS:
All patients with stage IIIc or IV ovarian carcinoma who presented for second opinions after primary surgery was performed robotically were offered a laparotomy and attempt at complete cytoreduction within 6 weeks of initial surgery.

RESULTS:
Nineteen patients met the inclusion criteria. The median age was 51 years (mean 51.4, 95% CI 47.3-55.5). Thirteen patients were said to have no residual disease while 6 patients were declared optimally cytoreduced after robotic debulking. Significant differences in cytoreduction were found in 15 of 19 patients at time of laparotomy (P=0.028). All 13 (complete cytoreduction) patients were found to have residual disease with 9 of them having disease greater than >1 cm and four of them with disease < 1 cm. Of the six patients optimally robotically debulked, four had disease < 1 cm and two had gross disease >1 cm. In all 19, complete cytoreduction was attained. Fifteen patients had residual disease after robotic debulking in the upper abdomen (diaphragm, liver, infragastric omentum), thirteen had residual disease on bowel mesentery or surface, and nine had residual disease in the pelvis. The median hospital stay was 3 days (mean 3.53, 95% CI 3.02-4.04).

CONCLUSION:
It appears to be very difficult to accurately access the level of cytoreduction at time of robotic surgery. Open cytoreduction can achieve no visible or palpable residual disease after a robotic surgery.
Blood Gas Analysis Utility Predicting Multiple Organ Dysfunction Syndrome in Obstetric Patients [38E]
Authors: Eliana Montoya , Carrizosa Jorge , Castro Alejandro , Sanchez Alexander , Nino Reinaldo 
Published: May 2017

INTRODUCTION:
Every day, 800 women die for pregnancy causes around the world, 99% of those in developing countries. The multiple organ dysfunction syndrome (MODS) occurs in 15% of patients in critical care, with a related mortality up to 80%. Some values of arterial blood gas (ABG) analysis has been proposed in few publications in obstetric patients and its relationship with bad outcomes.

METHODS:
The aim of this study was to describe blood gas thresholds as a risk to develop MODS in obstetric patients. A retrospective case-control study was conducted in four hospitals of Bogota, Colombia, between 2008 and 2014. Logistic regression analysis was conducted.

RESULTS:
We collected information form 277 cases and 558 controls, of them, 84.9% was pregnant and 15.1% in the puerperium. The mean age was 27.8 years old (SD 7.3), the main diagnosis were hypertensive disorders (52.4%), bleeding (12.2%) and sepsis (12.2%). 490 patients had at least one ABG test, pH, PO2, PCO2, lactate and base deficit were measured. A multivariate analysis was performed, with strata by every main diagnosis as mentioned before. Association with MODS was found in lactate higher than 1.2 mmol/L (OR 2.2 95%CI 1.5-3.4, p < 0.000) and pH less than 7.35 (OR 5.2 95%CI 2.6-10.6, p < 0.000) for patients with preeclampsia; for hemorrhage a base deficit 9 (OR 2.0 95%CI 1.2-3.3, p < 0.006) was founded. There was no association with sepsis founded.

CONCLUSION:
Patients with MODS and preeclampsia the better ABG predictors were lactate and pH values, and for patients with hemorrhage, base deficit was identified. Prospective studies are needed.
Impact on Decisional Quality With Implementation of a Shared Decision Aid for Contraceptive Choice [2F]
Authors: Sridhar Aparna , Lambrechts Sylvia , Kwan Lorna , Munnangi Meghana , Abutouk Mona , Saigal Christopher 
Published: May 2017

INTRODUCTION:
The best contraceptive choice for a woman is one that takes into consideration their personal preferences and contraceptive needs. Shared decision aids have helped patients to identify the choice that likely best matches their needs.

METHODS:
A quality improvement project is being conducted at University of California Los Angeles. Patients were sent a web-based educational decision aid via an online patient portal prior to their appointment. We compared their decision quality, level of familiarity with various contraceptive options, satisfaction with decision, decisional conflict, shared decision making, health literacy and patient experience with a group of patients that did not receive the decision aid.

RESULTS:
A higher proportion of women that received the decision aid were interested in highly effective contraceptives such as intrauterine devices (20% versus 10%, p=0.0849) and a lower proportion were interested in less effective methods such as condoms (7% versus 23%, p=0.0055) compared to women not receiving the decision aid. Participants with low decisional quality (SURE=0-3) reported more decisional conflict than those with high decisional quality (SURE=4), regardless of whether or not they received the educational content (1.67 vs 1.23, p=0.0079; 1.88 vs 1.23, p=0.0002, respectively).

CONCLUSION:
Patient education aids offer patients information about contraceptive options, which may impact their contraceptive preferences. The quality improvement project is ongoing and we will collect more data to assess the effect of shared decision aid on the decisional quality and conflict. We plan to perform qualitative studies to further understand the factors affecting decisional quality.
Patient Preferences About Immediate Postpartum Long-Acting Reversible Contraception: A Qualitative Study [10F]
Authors: Soliman Ann , Dalton Vanessa , Moniz Michelle 
Published: May 2017

INTRODUCTION:
To acquire in-depth understanding about patient preferences regarding the timing of long-acting reversible contraceptive (LARC) insertion after childbirth.

METHODS:
We conducted semi-structured interviews with pregnant women planning to use LARC postpartum (n=5). Participants watched a standardized video explaining LARC insertion timing options. Interviews were audio recorded, transcribed verbatim, and coded by two authors (AAS, MHM) using qualitative content analysis.

RESULTS:
Interviewees identified a variety of personal preferences for timing of LARC insertion. Cited reasons for preferring immediate postpartum insertion (n=3 women) included strong desire to prevent rapid repeat pregnancy, wanting to initiate contraception prior to being occupied with a new baby, and ability to address potential issues with their LARC device at the postpartum visit. Women (n=2) preferring outpatient insertion reported wanting to let the body recuperate after childbirth before initiating contraception and concern about expulsion and potential risks to breastfeeding with immediate insertion. Regardless of personal preferences for timing of insertion, all interviewees supported making immediate postpartum insertion available to women. Participants reported enthusiasm for discussing contraceptive options with any provider at any time during their prenatal care visits and expressed an affinity for receiving information via in-person conversations and visual formats (e.g. video, pamphlets) that could be shared with a partner.

CONCLUSION:
Our findings suggest that pregnant women have a range of preferences regarding timing of postpartum LARC insertion and support making immediate postpartum insertion available to women who desire it. Enhancing access to this service may align with women’s contraceptive preferences and enhance their ability to meet their reproductive goals.
Attitudes and Barriers to LARC Use in a Young Adult Population in Florida [11F]
Authors: Schickler Robyn , Holmstrom Shelly , Pargas Anaisy , Nandyala Arathi 
Published: May 2017

INTRODUCTION:
In 2011, the unintended pregnancy rate decreased from 51% in 2008 to 45%. Of women using contraception, 7.2% were using a LARC in 2011-2013 as compared to 1.5% in 2002. Increasing LARC use decreases unintended pregnancies, however, data are lacking regarding barriers to the uptake of this contraception. The purpose of this study was to identify the barriers to adoption of LARC in a young adult population in Florida.

METHODS:
This project is a computer-based survey of females aged 18 to 30 at our institution’s satellite clinics. Survey questions address age, race, education level, insurance, income, obstetric and sexual history, and contraceptive use, knowledge about efficacy, safety, and misperceptions of intrauterine contraception.

RESULTS:
We found that 5.3% of the participants use an IUD and 57.9% use no method of contraception. One third of patients answered correctly about the failure rate of “typical use” of a LARC, and 40% of patients answered correctly the failure rate in “perfect use” of a LARC. About half of patients believed the IUD increases risk of pelvic inflammatory disease, and 40.9% believed that it causes infertility. Moreover, we found that patients are most influenced by their gynecologist regarding contraceptive options.

CONCLUSION:
Based on these findings, education is likely the main barrier to uptake of a LARC method. Gynecologists play a key role in providing contraceptive counseling and education to our patients, and should make this education part of every visit with our patients to provide them the most comprehensive care possible.
Oral Contraceptives. Is It Time for Over-the-Counter Access? [13F]
Authors: Fedorova Ekaterina , Feldman Scott 
Published: May 2017

INTRODUCTION:
A prescription-only requirement to dispense oral contraceptive pills is a major contributor to a high percent of unintended pregnancies. It is hypothesized that removing a prescription-only requirement for oral contraceptives would decrease the rates of unintended pregnancies without adverse effects on patient health.

METHODS:
This review has been conducted based on the analysis of data collected across studies obtained from PubMed. Articles were excluded on the basis of content found in its abstracts and full text versions. Specifically, articles that studied attitudes or views of physicians, pharmacists and women in regards to over-the-counter and behind-the-counter availability of OCPs were included. Studies on safety that analyzed patients’ ability to self-screen for contraindications were also evaluated.

RESULTS:
Patients who receive oral contraceptive pills (OCPs) without a prescription have higher rates of compliance than those who receive drugs with a physician’s prescription. While drug safety remains of a concern, implementation of self-screening checklist can be utilized as a solution. Screening by pharmacists is needed during the initial phase of OCPs transition towards over-the-counter availability. Appropriate training must be provided to pharmacists to ensure consistent quality services provided to patients. Data has shown that patients would continue to receive regular gynecologic examinations regardless of how OCPs were obtained.

CONCLUSION:
Evidence from countries where OCPs are available over-the-counter or behind-the-counter provides examples of numerous benefits, favoring uninsured and low-income females. This paper concludes that making OCPs should be made available without a prescription and that it would decrease the rates of unintended pregnancies.
Knowledge, Attitudes, & Practice of Long-Acting Reversible Contraception Among Women Experiencing Homelessness [22F]
Authors: Douglass K. Marie , McKean Rachel , Van Dommelen Kaylee , Meshbane Karyn , Poquette Amelia , Curry Christine 
Published: May 2017

INTRODUCTION:
Homeless women are a vulnerable patient population at increased risk for unintended pregnancy and face unique barriers to obtaining contraception. With failure rates of less than 1%, long-acting reversible contraceptives (LARC) have shown to be effective for reducing unplanned pregnancy rates. This study evaluates attitudes toward pregnancy and contraception among this demographic.

METHODS:
52 women at the Lotus House Shelter in Miami were surveyed using an adapted version of the validated “National Campaign to Prevent Teen & Unplanned Pregnancy.” We conducted a focus group with 14 women to better understand attitudes towards contraception.

RESULTS:
The majority of survey respondents had previously been pregnant, with 81% experiencing an unintended pregnancy in their lifetime. Nearly 60% wanted to delay future pregnancies for at least 3 years or avoid pregnancy entirely. 89% had received a sex education class, yet less than half covered the importance of contraception or available methods. Levels of LARC utilization were low (4%), and the survey revealed a deficit in knowledge accompanied by a desire to learn more and potentially utilize this contraceptive method. From the focus groups, themes relating to factors affecting contraceptive use and side effects were the most common.

CONCLUSION:
Participants demonstrated high rates of unintended pregnancy and desire to avoid pregnancy for an extended period of time. Women experiencing homelessness may be excellent candidates for LARC. This data will be used in the development of a contraception intervention to address the unique healthcare needs and potentially alleviate the burden of unintended pregnancy in this population.
Pregnancy After Periviable Birth: Making the Case for Postpartum and Interpregnancy Care [27F]
Authors: Vani Kavita , Wolfe Nancy M. , Facco Francesca , Himes Katherine 
Published: May 2017

INTRODUCTION:
Women with a history of a periviable birth are at risk for recurrent preterm delivery. We sought to determine postpartum follow up rates, interpregnancy intervals (IPI) and uptake of 17OHPC in women with prior periviable preterm births.

METHODS:
We used data from the Magee Obstetrical Medical and Infant Database from 2008-2014 to identify women with a periviable birth of a singleton gestation due to spontaneous preterm labor or PPROM between 20 and 26 weeks gestation. Chart abstraction was performed for women who had a subsequent delivery at our institution by the end of 2015.

RESULTS:
Of the 361 spontaneous periviable births at our institution, 63 (17.4%) women had a subsequent delivery. The rates of recurrent preterm birth (less than 34 weeks) and recurrent periviable birth were 27% and 12.7% respectively. 42.9% of women had an IPI of less than 12 months and only 55.8% of women returned for a postpartum visit (PPV) after their periviable delivery. In the subsequent pregnancy, 20.6% of women did not receive 17OHPC, most commonly because of late presentation to care. Women who did not return for their PPV were less likely to receive 17OHPC in the next pregnancy (57.1% vs 94.1%, p=0.001).

CONCLUSION:
Non-compliance with the PPV and short IPI were common in women with a prior periviable delivery. Compliance with the PPV was associated with higher rates of 17OHPC administration in the next pregnancy. These data suggest that strategies should be developed to improve postpartum care and counseling regarding risk reduction for women with a periviable birth.
Pregnancy Patterns of Exercise and Physical Activity [35F]
Authors: Moore Iris , Johnson Amy , Mason Mikayla , O'Sullivan David 
Published: May 2017

INTRODUCTION:
Despite the numerous health benefits and approved recommendations from the American College of Obstetricians and Gynecologists, a significant portion of women do not participate in exercise during pregnancy. The aim of this study was to examine exercise habits during pregnancy, the health effects and potential benefits on the mother and baby, and the levels of counseling mothers received from their healthcare professionals.

METHODS:
A questionnaire was distributed to women postpartum that queried if patients had discussed exercise with their obstetrical provider, exercise participation prior to and during pregnancy and potential barriers to exercise.

RESULTS:
A total of 101 patients were surveyed and 70.6% of patients who exercised in the first trimester continued to exercise in the third trimester. Of those who reported a lack of exercise in the first trimester (n=27), 44% (n=12) went on to exercise during the third trimester. There was a statistically significant difference in the average weight gained by the third trimester between women who exercised and those who did not (30.5 vs. 37.2 lbs., resp.; p=0.02). There was no difference in newborn birth weight. 69.1% (n=66) of women reported receiving exercise counseling from their healthcare provider. Women who received counseling reported a higher rate of compliance with exercise (77% vs. 51.7%, p= 0.028) vs. those who did not receive counseling.

CONCLUSION:
Women who exercise benefit from gaining less weight during pregnancy with no negative effects on newborn birth weight. Exercise counseling was associated with an increase in exercise compliance.
The Effects of RF Excited Fractional CO2 Laser on the Vaginal Canal in Treating Stress Urinary Incontinence [2G]
Authors: Patel Falguni 
Published: May 2017

INTRODUCTION:
Stress Urinary Incontinence (SUI) affects 15 million American women. The causes of SUI include pregnancy, childbirth, obesity, menopause and chronic coughing. The current treatment options include Kegels, bio-feedback stimulation, bulking agents, pessary and surgical correction. Recently laser treatments have been reported as a treatment option.

METHODS:
Women suffering from SUI as evaluated by questionnaire, pelvic exam and urodynamic studies showing maximal urethral closure pressure (UCP) of less than 40 cm H2O, were enrolled in the study. Subjects received three fractional CO2 laser treatments four weeks apart. CO2 laser energy in deep mode at 50 mJ at 5% fractional density was delivered in the vaginal canal. The second pass of the laser was done at 1 and 11 o’clock. Subjects were then reevaluated at one month and three months post treatment, using a questionnaire for incontinence and a urodynamic evaluation to determine max UCP.

RESULTS:
Twenty women between the ages of 31 and 69 enrolled in the study, tolerated the treatments well. The subjects reported minimal to no treatment discomfort and no adverse events. At one month post treatment of the series, reported in 100% correction of SUI based on the questionnaire. The subset of subjects who completed three months post treatment underwent urodynamic reevaluation showed an increase in maximal UCP from 19 to 33 cm H2O pretreatment to 45-73 cm H2O.

CONCLUSION:
This study shows fractional CO2 laser is a safe and effective treatment and may be an option for the improvement of SUI which would have an impact on the quality of life.